Confidence Booster

I think at times as students we often don't realise how much we know or the extent of our skills. By the end of fourth i think that we are all equipped with the skills to work in just about any area of physio practice. On my last placement in India i realised how much i have learnt and the extent of my skills. India was a dificult prac to prepare for as there was no specific type of patients, there was literally a bit of everything. Add to that the fact that resources were extremely limited and there was a significant language barrier between the students and the patients, and it became quite a challenging prac. WHilst in India myself and one other physio student were the only physios over there. Our supervisor was an OT and she was only there for about a week. As such we were very busy and every patient with any sort of physio related problem was referred to us. I found that i was able to confidently treat every patient i saw despite being presented with a huge range of conditions, having no supervisor to consult, and having very limited resources. This gave me a huge boost in my confidence in my knowledge and skills, and also in my ability to think on my feet and be resourceful. For me this was an ideal prac to finish with as it forced me to combine everything that i have learnt throughtout the physio degree and reinforced the knowledge that i am capable to function as a physio in any area of practice.

The bigger picture

During my placement in India i realised that as Physios it is easy to get tunnel vision and only focus on specific aspects of a patients disorder without thinking about whether addressing thewse issues will really make a drastic improvement to the patients quality of life, or whether you are likely to be able to actually improve these issues. A lot of the children i worked with in India had such severe disabilities that i had to step back and decide what was really going to benefit them the most. Many of the children had extremely severe fixed contractures due to the poor managemnt of their spasticity. In these childrren it was easy to get fixated on trying to lengthen their short muscles however i realised that one i wasn't going to be able to make much diffenece on a fixed contracture ( although it is important to prevent any further loss of range) and two that these children would benefit the most from interventions that would allow them to play and interact with the other children. Whilst over there i was working with OT students which i found quite interesting as they seem to take a far more holistic approach to treating their patients. I found that many of my patients benefited more from structured games with other children where they could learn to socialise and interact, than from specific individual physiotherapy sessions. Having said this i found that many children benefited a great deal from individual physio sessions but i learnt that you have to look at the whole situation with each patient and realise that certain patients may not get as much benefit from typical physio interventions. With these patients i think it is necessary to take a more holistic approach and to recognise what it is, whether it be physio related or not, that would make the biggest difference to the patients life.

Independence

During my placements this year i have found that i have enjoyed most of them however i have also found that my stress levels have been pretty high. This had been a bit of a concern for me as i questioned whether it would be the same once i graduated and entered the workforce. During my most recent placement in India i managed to relieve some of these concerns. The placement was considered a rural and self-directed placement, and whilst we were over there we had a supervisor for about a week and then were left to our own devices. I found that being given the independence to make my own decisions about treatment palns and not having to worry about justifying everything to the supervisor, i got so much more enjoyment out of working. I am very confident in my skills and knowledge so i was not concerned about the extra responsibility that had been placed on my shoulders and it was so refreshing to be able to make my own choices as if i were actually out in the workforce as a qualified physio rather than a physio student. As students i think we are shaped by our supervisors and their personal views and a lot of physios differ in their opinion on how things should be done. Both physios may be right and have good reasons to back up their choices and as such are just presenting two alternative options. As a student we are forced to follow the opinion of our supervisor and often don't get the chance to approach things in our own way. Working in India gave me the opportunity to do things in my own way which i found thoroughly enjoyable and far more satisfying than following someone elses views. Hopefuilly this is what it will be like when in the workforce.

Professional differences

I have just completed a placement in India working at a refuge centre for people with mental and physical disabilities. Whilst over there i was put in situations where i had to work closely with the other students with the patients. Some of the students i worked with were quite strong willed and would often try to push their opinion over others. Generally i am pretty easy going and will usually try to compromise in these situations rather than rock the boat, however there were several instances where i found myself in a position where i completely disagreed witth what the other student was suggesting. Whilst normally i would try to avoid these kind of situations i found that i actually gained a lot from them in terms of learning how to handle the situation in a way that ensured no one left feeling offended but the right treatment choices were made. The instances i have mentioned invloved patients that i was very confident about treating and knew I had more experience in treating these patients than the other student. Rather tahn tell the other student that i thought they were wrong i simply outlined what had been taught to me on previous pracs with similar patients and explained the reasioning behind my treatment choices. I did this in such a way that i did not come across as being rude or dismissive, but rather as though i was inviting the other student to have an open discussion about the patient. The other student was able to see that there was sound rationale behind my treatment plan and agreed that what i was suggesting was probably the better option. I feel that these instances have taught me a valuable lesson about how to deal with disagreements between staff members.

Examination Pressure

I recently had my cardio prac at ICU in Charles gardiner hospital. Whilst there i found that i particularly enjoyed the prac and felt comfortable and confident with my knowledge and skills. All the feedback I recieved from my supervisor throughout the placement was positive and i felt confident that i would breeze through the prac without any drama's. Unfortunately i managed to let myself down by struggling under the scrutiny of my supervisor whilst seeing my examination patient. In previous pracs i have found that i have had some nerves when it came to the examination patient however not to the same extent as this one. Although my performance with my examination patient was not the best I still did enough to pass the prac relatively easily and my supervisor informed me that had it not been for my final examination i would have recieved almost perfect feedback. THis situation alerted me to the fact that i do not perform well or think as clearly when being scrutinized by others. Whilst it may seem that this is unimportant as once we graduate we won't be examined, I think it is something that i need to overcome as i am sure there will be situations in the working environment where senior physios will observe and scrutinize our work. If this is going to be the case i would not want to succumb to the pressure and fumble around when i know that in normal circumstances i can do the job perfectly.

Too many cooks spoil the broth?

I have had a couple of placements now where I have had numerous supervisors. Whilst this annoyed me originally because i was never sure who i was supposed to be reporting to and i felt like i was sometimes getting conflicting opinions, I now think that it is not necessaily a bad thing. I now realise that having input from as many physios as you are learning can only be a positive thing. It is great to watch how each physio approaches a situation and what treatment techniques they use. It is learning from these physios, as well as PD after we graduate that is going to shape the physios that we are going to be in the future. In my last placement alone I had two supervisors who had very different treatment techniques, both of which are effective. They were both willing to help me and demonstrate to me any techniques that I was interested in and I feel that it will only stand me in better stead for when I graduate.

What its REALLY like in the country

On my rural prac i was working with a physio who covered an area the size of Victoria with one other physio. There were some parts of the region that would only get visited once every four months and even then patients would not necessarily get seen if the timing of the trip happened to fall on a funeral day, or if they had gone to visit relatives elsewhere. It is not hard to understand then how frustrated she got when she received referrals from major city hospitals asking for weekly physio for patients that they were sending back to some of these remote communities. Sometimes it is necessary to keep patients in Perth, even though they would prefer to be home with their families, because it is impossible for them to receive the kind/amount of treatment that they require back in their community.
Seeing first-hand just how remote some of these communities are, and how little clinic time they get has made me realise how important it is to make VERY careful decisions about discharge from the larger Perth hospitals. Discharge planning for patients who live in remote locations is of the utmost importance and I saw some very sad cases of patients who were lost to follow up due to the remoteness of where they live. I saw children with significant feet deformities who were pushed around in prams at the age of 6, and young men post-stroke who would have returned to normal function if they had had adequate rehab.... yet they have lost function of limbs.
I dont want to sound like I've jumped onto the "woe is us in rural" bandwagon, but it has really opened up my eyes to the reality of rural physiotherapy and the need for increased communication between the major perth hospitals and the rural hospitals to ensure that each patient is able to receive the treatment that they need and deserve.