One thing that I think is super important to our own development is helping educate others. An easy way to do this is to start taking PT students on clinical rotations.
Over the years, we’ve had so many awesome PT students, we’ve really been lucky, and they’ve helped shape how we see our role developing them.
Here are some tips for those just getting started as a clinical instructor or for those that want to get even better.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 282: How to be an Amazing Clinical Instructor
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Show Notes
Transcript
Student:
So, yep. Michael from Chicago asked, who’s your best advice for being a clinical instructor for a final rotation student?
Mike Reinold:
Awesome. Good question, Michael. We’ve actually received a few questions like this in the last six months or so. I like how Michael kind of put final rotation student. That’s something I don’t think we probably put a lot of attention to, is somebody that’s literally going to be a PT on Monday, when they’re done with you. It’s a little different to think of it that way. But I think this is pretty good. I don’t think I’m the best clinical instructor in the world so I’m going to let you guys kind of answer this a little bit. And I don’t know, I think we can kind of build this here, but I like this because I think we can all do a better job as being clinical instructors. And this is something Lenny and I have been talking about at Champion for the last year. And I know Mike’s put a lot of effort into kind of reforming this with us a little bit. I think we do some things well but I think we can always get better. But I don’t know. What do you think? What does it take to be an amazing clinical instructor? Who wants to start?
Lenny Macrina:
I can begin, I guess, because I am the official, what, I don’t even know what the term is, ACCE, CCCPD of Champion. And so I do gazillion CPIs every year. I just think, in my head, when I have a student come in, I’m going to assume they have a base of knowledge. They can measure with a goniometer, they can do manual muscle testing, all the stuff that the school requires you. So now it’s up to me over eight, 10, hopefully 10 to 12, or 16 weeks would be perfect, the longer the better, that I can use those basic skills and have you apply it to the patients that are coming in and think in a more advanced and critical mindset because I know, like you said, on Monday, so to speak, they will be independent and a PT themselves. So I want them to begin to think in that fashion.
Lenny Macrina:
So I am not just breathing down their throats, watching every move they make, unless I see something really bad happening, which is not very common. It’s more, I want them to think. It’s not going to be life threatening if they make a mistake. But I also want them to think actively and have to kind of react to people and how people talk to them and how they talk to people and how people present and have to respond all that.
Lenny Macrina:
So my goal is to give them a ton of evals, critically think through it, let them kind of spread their wings a little and I’ll kind of nudge them along and kind of guide the process. And hopefully, they can critically think through the process. And if not, I will help them critically think through the process and then help them with their notes as well. That’s a big thing as well. I see some notes come through sometimes and it just doesn’t capture everything and it has to capture everything that’s going on in that session for that day. And so I’m just trying to help with that as well. Kind of a vague, general response. But I want them to think independently versus me having to spoon feed them the information.
Mike Reinold:
Yeah, that’s great, Lenny. I like how you divided it kind of into two things a little bit there. There’s clinical reasoning and then there’s skill development. So I know with our students, we spend a lot of time going over to the side and practicing a skill or encouraging them to practice skills on each other all the time. That’s different than clinical reasoning. So I think that would be a good first thing. If you’re a new clinical instructor and maybe you’re having some imposter symptom, refer back to last episode, if you want to hear about how to deal with that, but maybe you’re some imposter syndrome being a new CI with somebody, is think how do you help develop skills, but also clinical reasoning? Good stuff, Len. I like that.
Lenny Macrina:
And I think also interacting with people is a huge thing. And so I tell them and I try to tell them, “Watch how all of us, the seven PTs, talk to their patients.” There’s a reason why I do everything I do during the day. I am not doing cartwheels because I want to do a cartwheel in the middle of the day. I am not talking to somebody with chronic pain because I want to sit there and stare them in the eyes and listen to every word and try to help them interpret their pain. Everything I do has a purpose for that particular person sitting in front of me because they have a journey and a story that’s different from the person that just left and I need to try to read them, figure out the issues and try to interpret things a little bit better for them so they are not fearful and everything else that they are with their life. So in my interactions with them, also, I want them to observe. So you four goofballs, hopefully you’re doing that.
Mike Reinold:
But you and all of us, I think, we also tell the students that too. And I think that’s one thing as a clinical instructor too, is realize that a PT student is really bogged down probably with minutia. They’re like, “Oh my God, I don’t remember how to do a Lachman test.” And they may miss that learning from your interaction with that patient, which was actually a really valuable thing. So I actually like how we draw attention to that. So that was pretty good. I saw a couple hands. Who wanted to go next on that one? Mike, I think I saw first.
Mike Scaduto:
Yeah. I think the communication aspect is really one of the biggest things that I see that clinical students can improve on, especially in their final rotation. So subjective history taking is such a huge part of what we do as clinicians. The patient will pretty much tell you or give you a pretty good idea of where to look in your clinical exam if you do a thorough and thoughtful subjective history. So it seems like clinical students typically come in and they have this list of questions. They go down the list one by one, and they may not be tied together and it’s kind of choppy and not very conversational. And I think as you gain experience, you start to make it more of a conversation with the patient with follow up questions that kind of make sense based on what they said. And you’re not just jumping from one topic to another, because you have all these questions that you want to ask.
Mike Scaduto:
So I think when I work with a student, something that I’ve actually really tried to work on, is not interrupting the student when they’re doing a subjective and trying to butt in and kind of guide the conversation. I will if I need to, if I feel like it’s kind of gotten off track. But trying to let them explore how to turn the subjective history into more of a conversation, get comfortable talking in that manner and trying to explore that on their own without me kind of interjecting all the time.
Mike Reinold:
Yeah. That’s great. I like that.
Dave Tilley:
I can build off Mike’s too because I feel as though obligated to share this. People may not know [inaudible 00:07:41] but I actually failed a rotation and was kicked out of PT school and had a nightmare interaction with my CI.
Mike Reinold:
I like that you’re sharing this because, I don’t know, we’ve had some really bad students, I’m just kidding, and it’s so hard to fail. I mean, did you injure a patient? What happened, Dave?
Dave Tilley:
It’s a long discussion and I own a lot of the accountability for it. But yeah, the CI interaction with me and her was not great. So let’s just say that. She had failed other students and no students went back after me. Let’s just leave it at that.
Dave Tilley:
Something that I’ve taken away from that experience that I try to work with the students is I understand, and I completely understand, I think it’s important, like Mike was saying, to let them kind of feel it out. But you have to understand the comfort level of the student to work in that environment, especially with more complex patients or more complicated situations. And so we work in a very high level situation. Some people come to us with really high level sports or things they’re going through. And sometimes you might start an eval with someone or give someone patient and start to realize quickly it’s a lot more complicated maybe than it’s starting to lend on to be.
Dave Tilley:
So I remember in one of my experiences, I got asked to do something very early in my clinical experience that I didn’t consider injury level. It was a very complicated patient who was literally in the ICU. And it was really, really overwhelming and I straight up told my CI, I was like, “Listen, I’m trying my best here, but I don’t feel comfortable.” And she literally just let me fry. She was like, “Figure it out. Let’s work through this.” And I was like, “I don’t know if this is the best place to try right now.” So this happened a couple weeks ago or maybe last month with a student, is I had someone start an eval with me and then instantly, as soon as I got through the subjective, it was way more complicated than I think the student was ready for. It was multiple pieces to a surgery. There was complications. There was neurological stuff going on. It was a really involved surgery. And I was like, “I’m going to take the reins on this one. [inaudible 00:09:27]. The next one, you can grab.”
Dave Tilley:
Because if I had let that person just swim, it would’ve been way too overwhelming for them. And I think the patient would’ve been like, “What’s going on here?” But it was really, really complicated. It was a very complicated shoulder situation. So I would just say gauge where the students at in terms of what they can probably handle and talk with them before. And then maybe if things are falling apart in front of you because it’s really hard, then maybe help them out a little bit more, then come back around.
Mike Reinold:
I like that, Dave, too. Put the students in a position to succeed. I think that’s an important thing. It’s okay to challenge them to get through their comfort level a little bit. You might say give them a little independence, but once they start flailing a little bit, that’s where you got to throw a life raft in there to help. But what do you think, Dan?
Dan Pope:
Yeah, I think Champion’s a little bit different because we have a kind of a group collaborative effort to try to help students along. It’s not one student, one CI, you follow all their patient caseload. It’s a little different than other places. But one of the things that I found was really helpful, I still try to do this somewhat, but it’s a little more challenging, is to ask students what their goals are from the get go because oftentimes, students are coming to Champion for a specific reason. And if it is their final rotation, usually that’s a student’s chance to go to the clinic they want to go to and usually, they’re trying to get something more specific out of that experience. And obviously as clinicians, we have expectations so we want to make sure that we get through the whole process of educating students to make sure they become ready to see a patient.
Dan Pope:
I think the other thing that’s really helpful is to ask about the goals for the student at the start, come up with a way to try to hit those goals, and then periodically throughout the course of their stay at Champion or wherever your clinic is at, we see if they’re hitting those goals, and if they aren’t, let’s try to work towards it. And if we are, great. Do you want to try to work towards anything else? So then by the end of the clinical affiliation, you feel like you’ve worked towards something that you wanted at the start.
Mike Reinold:
I like that. And if your clinical rotation has something like an in-service or something like that, you can tie that into that and make sure it’s something that they’re really involved with and interested in. I think that’s great. Diwesh, I mean, you kind of help coordinate our strength and conditioning interns, which is different than a PT clinical intern. But we do have some of them that are doing it as a requirement for their degree and also some that are doing it for education. As an internship leader, you do a lot of education for them. Any advice for somebody just getting started as a coordinator of that sort of thing?
Diwesh Poudyal:
Yeah. I think the first thing for me is you really have to be invested in the role. You got to really be ready to give your efforts and your time and energy into it. And the big one, at least from my situation, specific to Champion is kind along what Dan said about making sure you kind of know what their goals are. Because we do get someone who’s a senior in their undergrad that is trying to figure out their career path, or someone who’s already got their master’s in strength and conditioning and wants to get a little bit more fine tuned or refined into some of these skillsets, or we get PTs that are currently practicing that want to get an understanding of the strength and conditioning realm of things and learn how to load and progress and regress and stuff like that. So really, you do really have to kind of cater to what they need and what they maybe want to get out of the situation. So understanding that and building that relationship first is definitely going to go a long way.
Diwesh Poudyal:
Now, on top of that, again, I like to plan to succeed. So I have a pretty well laid out full curriculum that they follow. We do an on-ramp week, where the first week of their internship we’ll do an inservice every single day to get familiar with topics or at least some of our systems so they can be not deer in headlights when they’re in the facility right away. So they have something to base some of their visuals off of, at least something to gain an understanding of why is this happening in a certain way or what’s the reasoning behind something might even start this way.
Diwesh Poudyal:
And then after that, we do a weekly inservice to cover each topic that might require a little bit more in depth stuff or that might build on each other. And then other weekly readings and [inaudible 00:13:42] to go along with it that they do at home. So kind of, again, goes to show it does require quite a bit of investment and you do have to be all in on that role of trying to be an educator and a mentor. So that’s kind the advice that I would give. Just be in it.
Mike Reinold:
Yeah. I like that. And I know places that do like weekly inservices and have set times and stuff like that. And I also know places where that’s unrealistic. It’s just hard for them to do that. But I think we do do that at Champion, which is pretty good. We have a lot of outside leading that we try to guide them through, like here’s something you should watch or here’s something you should read to kind of evolve you through there.
Mike Reinold:
You guys had some great input with all this. I think the only thing I would add is, remember, we always talk about this framework, and everybody on this Zoom call is sick of hearing me, but hopefully, you guys listen a little bit different, but again, your development. Knowledge, skill, experience, judgment, So I think I want you to get tons of experience at Champion. I want you to leave Champion with at least the things that we see a lot of with some self confidence and experience in certain things.
Mike Reinold:
So I use that framework all the time of I do, we do, you do. I do that all the time. You observe me doing it, then we’ll do it together, and then you do it with me observing you, and then you get your reps and get your independence in there. And it’s really fun to see the students do that. And I think sometimes the students, you get tired. You’re doing a lot of the manual labor throughout the day. But it’s super designed that way because at end of the day, you’re like, “Man, I did that one manual drill probably 600 times in the last 10 weeks.” So your self confidence in your ability to do that just went through the roof because it’s about repetitions. So that would be the other thing I would suggest.
Mike Reinold:
So awesome stuff. I mean, I think that’s some really good feedback if you’re just getting started it as a clinical instructor. So hopefully, you can take some of that advice and start applying it. But I think the biggest thing, if you take what Diwesh kind of ended with there, is go in with a plan and you’ll be a little bit more likely to succeed. And when a doubt, just take a step back and talk to the students. Some of the best education for me tends to happen at the end of the day when I’m done and I know I have an hour before I need to go to wherever I need to go next and we just sit around and we just talk. I get to hear what’s on the students’ minds and talk a little bit.
Mike Reinold:
And with COVID, I think everyone’s been trying to get in and out of work a little bit faster. But to me, I think some of that is some of the best times. So keep that in mind too. Maybe some unstructured interaction sometime is important. The students just think I like to stay in the clinic and work on my putting stroke, which I do, but it’s so we can talk and I can hear them think a little bit because it’s about developing some of those skills.
Mike Reinold:
Awesome. So great job. I appreciate it, Michael. Thank you for the question. If you have something like that, head to MikeReinold.com, click on that podcast link, and we will answer it in a future episode. Please head to Apple podcast, Spotify, rate, review, subscribe, and we’ll see you on the next episode. Thanks again.
