Final entry- placement 2

Reflecting back on this placement, I felt I have learnt a lot and have had some challenging experiences which I feel will and have already helped me grow as a physiotherapy student. I was quite anxious about working in a tertiary hospital and I did find it was a very busy environment as I expected. I was concerned about my difficulties with time management and upon commencing this placement it was not very good and I did not cope very well with having a large case load. Although by the end of the placement I was able to deal with this a lot better and learnt strategies which I used to improve on my time management and will continue to use. I still need to work on this however. Also, on reflection there were a lot more time constraints with seeing patients with this placement compared to my last one and I took a while to adjust to such a fast paced setting.

I was nervous about having a day every week where I see complex patients. I have to admit I was nervous every week when this day came as you do not know any of the patients who come in and cannot specifically prepare. They get referred from their GP's and all have various musculoskeletal issues ranging from chronic LBP to recurrent shoulder dislocations. Towards the end of the placement I was more confident in 'having a go' with these patients and choosing to see those that may have been more challenging. When going back to structure - structuring my thoughts and my assessment- and thinking of the basics rather than getting too overwhelmed by patients' presentations I was able to handle these days much better. I learnt (with the help of both my supervisor and tutor) to pick out the main subjective and objective asterisk findings and let these guide my intervention instead of trying to assess and then treat everything in one single session. For example, I saw a patient post- rotator cuff repair who also had cervical spine pain which was related to her presentation. I felt as though I needed treat both her shoulder and neck and other remote mechanical factors with exercises and massages, etc. After talking to tutor, it was simply a matter of doing two or three main things in the session such as assessing her neck and giving her ROM exercises for her shoulder and educating her. Approaching situations in a more structured way and prioritizing aspects in a situation will help me when dealing with cases that are not so straight forward or 'textbook' in presentation in the future.
I was worried about my technical skills with treatment and with physical examinations and I felt these improved somewhat over the course of the five weeks. The placement really encouraged me to make sure I knew what I was assessing and why I was assessing certain things. It also made me ask myself what the aim of a treatment technique was and if in fact I was achieveing this aim as effectively as possible. This pattern of thinking I believe will stay with me and I can make sure I put it into practice on my next placements. I was also apprehensive about my approach to back and neck pain. I saw a lot of lower back pain patients - mainly chronic- and I feel I am more confident with running through an assessment for these patients. I still need to gain more confidence with my treatment choices though. I learnt a lot about approaching chronic low back pain and spotting yellow flags and even how to deal with these. I do not find it nearly as overwhelming as I used to!

Overall, I have grown more confident in interacting with patients and educating patients although I do need to trust in myself more and remember not to let myself get overwhelmed when challenging experiences come my way. I am starting to feel a bit more like a professional physiotherapist rather than a student now and made sure I tried to bridge the gap between these during the past five weeks.