Ask Mike Reinold Show

Getting the Most Out of Your PT Clinical Affiliations


It is important as physical therapists that we are exposed to a diverse range of the profession during school.

Many students that want to get into sports or orthopedics feel like they don’t get as much out of the PT clinical affiliations outside of those areas.

But, we think there’s a ton to learn in every environment that will help you with your future career.

To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 322: Getting the Most Out of Your PT Clinical Affiliations

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Right. Colton from Philadelphia asks, “Hi, Champion PT. I’m a third year GPT student and just started my last clinical affiliation in a hospital-based outpatient setting. I already have a job lined up with an outpatient PT clinic after graduation that sees people one-on-one. My current clinical affiliation includes a smaller gym space with less equipment, less ortho diagnoses, and treats at least two patients an hour besides evals. I am nervous that I won’t see as many post-op and ortho patients to practice my manual and treatment skills. What advice would you have to make the most out of the clinical affiliation and preparation for graduation and working full-time?”

Mike Reinold:
Awesome. Great question, Colton. The first thing I thought of when I read that is you’re probably going to see more post-op patients in an outpatient hospital setting than you are in a one-on-one setting, assuming your one-on-one setting may be KAF based. Maybe I’m off-base on that. That could be wrong. But hospitals tend to see tons of post-ops, so you tend to get lots of good reps with those early post-ops, which is awesome to carry forward into your next setting when you’re outside of the hospital affiliation because you’ll have so many more reps with post-ops. So let’s see. I’d say give it a little bit there. You might start seeing more.

But I see what you’re saying. Maybe this is a little less ortho, a little less force. I mean, I don’t know. I appreciate the diversity. I appreciate some things that you may learn from this setting and be able to make you a better outpatient ortho physical therapist, but I don’t know, who wants to start with this? What advice can we give Colton to get the most out of this PT clinical affiliation? Because again, I think a lot of people are in this situation, right? They’re in an outpatient hospital that’s maybe a little bit more gen pop, right? And they want to get into something more like advanced ortho or sports. But what would we say for Colton? Mike, you want to start?

Mike Scaduto:
Sure, yeah. Although you may not be seeing, it sounds like, what your ideal patient population would be when you start working, there’s definitely a huge learning opportunity. So in a hospital setting, I would say really try and soak up all the medical knowledge that you can. You’re going to be working in close contact with a bunch of different professions, probably like OT, obviously physicians, tons of other professions that are experts in other areas of rehabilitation, diagnoses, and medical treatment. So I think from a medical perspective, that’s a really good opportunity to learn as much as you can, which you can then carry forward into outpatient orthopedic treatment. Potentially learn a lot about wound care in that setting as well. Learn as much as you can, and that will definitely transfer into treating not only postoperative patients, but probably all of your patients going down the line. I think the more experience you have, the better, and you get to put a lot of the knowledge that you learned in PT school to the test, and I think it’ll seamlessly apply into that setting.

Mike Reinold:
Awesome. And always to me, I think when you take a step back and say, “what can I learn from this environment?” I think that’s what Mike started off with. I think to me that is the best approach. There may be some doctor conferences that you can attend. There may be some grand rounds that you can attend. Learn to take advantage of that. But I’m sure a bunch of us have been in this setting. Who else? What do you think, Kev? What do you think?

Kevin Coughlin:
Yeah, I would just encourage Colton to go into the clinical with an open mind, because I think Mike just hit on some good points, that there’s interesting things to learn in each setting, and just because it’s not the setting you might want to be in long-term doesn’t mean there’s not a lot to learn. I had an outpatient rotation in a hospital-based setting, and even though the gym space was small and the exercise progressions kind of ended abruptly, I did learn a lot from a manual standpoint. I thought my instructor was super knowledgeable, and they had a really nice team approach, kind of like Mike was saying, too. And that was something that I definitely took with me going forward, being able to collaborate with other team members.

I also think sometimes, depending on where the hospital is, you can get some difficult cases. Sometimes you see more chronic pain type stuff, and that’s just another area that it will be helpful to get exposure in when you’re a student. And then the last thing I would say is if it’s not the setting that you want to be in long-term, outside of your clinical hours, go ahead and keep doing some con ed stuff. Read blogs, listen to podcasts, try to stay sharp in the area that you’re most interested in. But there’s definitely going to be something to learn, and you kind of go into it with a more positive mindset, I would say.

Mike Reinold:
That’s great. That’s great. I love that concept, too, of learning outside. Especially during clinical, you’re kind of in a different… You’re almost in a studious mindset where you go through the day, you have so many questions. If you just say, “Look, I’m going to go home. Before I have dinner, I just want to sit down and learn something for 45 minutes every night.” I think that’s a great way of doing it. Dave, what do you think?

Dave Tilley:
Yeah, I think two little nuggets to add. One is that I think that hospital settings really offer you a lot of opportunity to sharpen your soft skills, so to speak. It sounds like he’s talking more about the hard skills of PT, the manual therapy, the exercise that he wants to learn. But hospital patients, man, people are in pain. They’re really struggling. It’s not ideal. Nobody wants to be in a hospital. Nobody wants to have surgery. Nobody wants to go through that. And so I think I learned a lot in my hospital rotations about talking to people and being empathetic and trying to build trust and rapport with people, which for some of those settings, they’re not doing a ton, but to get them to be motivated and do stuff is challenging sometimes.

So I would say that, but two is think a little wider, too, on personal development as well. I’m sure some clinicians in there, they might love hospital-based PT, which is really hard, man. That’s a really hard area of PT. So maybe pick their brains about personal development stuff, career stuff, like business stuff. Try to think a little bit wider in terms of what you can get away from just like the best exercises for outpatient ortho. That’d be my 2 cents.

Mike Reinold:
Yeah, no, that’s a great perspective. That’s some of the skills that are a little bit harder to develop, too. And when you’re not focused on them, sometimes you miss them. So I like that, but…

Lenny Macrina:
I think this is the perfect opportunity for this kid. Sorry. This is a perfect… I mean, I did a similar thing working in Berm. You, too, Mike. We weren’t necessarily hospital-based, but we worked in a hospital where the doctors are doing surgery and the hospital is right there. And we saw so many cases, and we saw a lot of post-ops. It depends on your surgeons, but you’re going to see a ton of stuff. And going to a one-on-one clinic as a new grad could be a little underwhelming for you. You’re not going to get the experiences that you probably truly need. It’ll be a great pace for you, but you may not get the volume of people that is truly going to help you expedite your clinical learning and clinical decision-making skills like a hospital would.

So I think you get to spin this a different way, like Kevin said, is really take advantage of the different disciplines that you’re going to be working with, because you’re probably going to have speech, OT, obviously a bunch of PTs. You’re going to have access to doctors, probably observe surgeries, maybe sit in on their clinicals and be able to observe them, go to, like Mike said, grand rounds and any kind of learning opportunities that they’ve created within the hospital.

I think it’s a fabulous internship leading up to your one-on-one based job, so I would definitely take full advantage, because I know it has helped me a ton to have that volume of patients in my head to tap into over my last 20 years to apply to my current patients.

Mike Reinold:
You could always get better with a technique skill. That’s something you can always practice. Lenny just, and everybody really this episode, really had some amazing opportunities. So you could always get better at one technique. So I wouldn’t get too focused on that. But Lisa, what do you think?

Lisa Lowe:
Yeah, I have a couple different perspectives to add here. I think similar to what Lenny was saying, my first clinical and PT school for me was an outpatient hospital-based setting, and I still have patients in my head from that that are my continuous building of patient catalog of reference people for various conditions, whether there’s a couple people that I worked with who were undergoing chemo while they were trying to maintain their strength. There were some gunshot wound people. There were some different stuff that in that moment you get to see them in the beginning of their journey, and then you see them potentially in a traditional outpatient setting at just a different point. And I think seeing them in the beginning gives you a better perspective of where they’ve been and where you’re arriving at their next stage.

And having gone through personally the rehab continuum and having gone as a patient and outpatient setting in a hospital, even just looking around the room when I was there for myself, there is so much variety that you’re going to get to see that we’ve kind of all talked about. And there’s so much, I think, creativity that you can learn from the other PTs around you, from the occupational therapists around you, from… You know, doctors are continuously popping in and out. There’s just so many learning opportunities that are way different than once you get to that traditional outpatient setting, especially if you’re just one-on-one with a patient.

So like we’ve all been saying, right, open your eyes a little bit more to just observing the room around you and see what you can get out of not just your CI but the other PTs, because there’s a reason they’ve ended up there, right? They’re passionate about a piece of what they’re doing with their day, at least. So yeah, I think it’s a setting you can pull a lot more from than maybe just that surface interpretation.

Mike Reinold:
Yeah, I like it. Don’t get lost too much in this isn’t the specific diagnosis you’re going to be working with. Think about “what are all the other things that I can learn from this?” which is great. So Dan, what do you think?

Dan Pope:
Yeah, I’m just going to add one last thing quick. We already noted on this, but it’s a great opportunity when you’re around physicians. I get asked this question all the time. How do you develop relationships with physicians? Well, if you’re in a hospital, it’s probably one of the easiest places, and you get to see how they think, their clinical reasoning, why they’re doing certain surgeries. And I think that’s a link that we don’t have oftentimes in a standard outpatient clinic. We’re constantly trying to figure out how a doctor thinks.

This is a great time to start to see that, right? It’s like, “Oh, I do this surgery for this reason.” You kind of bounce those questions back and forth. And you can watch some of the surgeries. It’s one of the easiest settings to go watch a surgery. So I think that getting an idea of how surgeons think and seeing that is super valuable. It’s one of those things I wish that I kind of cared for more. I kind of had your mentality going into this. And then 10 years out from PT school, I was like, oh dang, I wish I had some more time to see how these doctors think and spend some more time watching these surgeries.

Mike Reinold:
Yeah, great perspective. That’s awesome. So Colton, I hope that helps, that answers some of those questions and gives you a little bit more kind of ideas on how to get the most out of that, because I think there’s some opportunity there. So if you have a question like that, please head to mikereinold.com, click on that podcast link, and keep asking away. And we will see you on the next episode. Thanks so much.

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