Ask Mike Reinold Show

How to Integrate Students into Clinical Care


As you probably know, we have a lot of clinical physical therapy students and strength and conditioning interns at Champion.

Over the years we have found success in integrating them into working with our patients and clients.

Here are some tips on how to do this while still being able to provide a great learning experience for the student and a great experience as the patient.

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

#AskMikeReinold Episode 328: How to Integrate Students into Clinical Care

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Show Notes

The Best Career Advice for Students and Young Professionals From The Experts in the Field


I’ve got the question today, Mark from California is asking, “How do you integrate PT students into a patient’s care in a way that makes the patient feel comfortable that they’re still receiving a high quality of care?”

Mike Reinold:
Ooh, good question Mark. I like that. You know what? That’s a really good question and that is something we at Champion, we talk about, and I would say we’ll expand on this question a little bit Mark too, because we have physical therapy students, but we also have interns with our strength and conditioning coaches in the gym, which is the same situation.

And I think what Mark’s saying is a dilemma that we all have is how do you, couple things, assure quality of care, which I actually think that part’s the easiest part. But more importantly is how do you assure that the person in front of you is confident in that quality of care? And I think that’s actually the real question here because we all trust and know that our students and interns are going to do a great job. But… That’s a good question, Mark. I like it. All right, who wants to start?

All right, Dave.

Dave Tilley:
I just didn’t want awkward silence.

Mike Reinold:
This is a good one too because again, Dave coaches youth, right? Again, you’re going to be able to answer. We’re going to have good answers for this question. All right, I’ll let Dave talk. Sorry, I was just excited.

Dave Tilley:
Yeah. And I have Mackenzie right now, so I feel like she can call me out if I’m not right here. But I feel like there’s a couple things. One is that you have to over-educate the student in advance that you might just take some Ls where people come to us, particularly out of network, they’re paying cash. There’s going to be some times that you meet the nicest, smartest, most wonderful person ever, but the person just literally drove two hours with their son or daughter and doesn’t want to see a student. And that’s totally okay.

But that being said, I think whenever we start with the students, and I think Scaduto also does a great job with this, is trying to get the students educated as fast as possible on the small treatment-based things that really don’t take a lot of super high-level skills. So doing a little bit of soft tissue stuff or manual work or coaching someone through exercises. Usually, you start somebody who’s working with the client with something that’s a little bit more basic. And so you do the eval stuff, you do the hands-on stuff for getting to know somebody’s range of motion or whatever. And then you go out in the gym and you’re both there and Mackenzie’s helping coach exercises or she’s helping through some basic stuff with modalities or whatever.

So I think you just start and that person can then talk to the patient or the client and establish rapport, like, “What are you in for? What’s going on?” And they feel more comfortable the first visit. And then if they come back the second time, you can say like, “Hey, take the lead and just catch up with this person and ask how their subjective is and see how they’re doing. And are they better or worse and just get them a hot pack or do a little bit of the basic stuff up front,” and then they can get a little bit more going in, hopefully, if someone’s there for an 8 to 12 week clinical. You can have a couple patients who feel really comfortable with the person. You have to read the room a bit and know that client is more open to students and just tell them up front.

But there’s many times when you start with just literally getting that person a heat pack and just talking to them for five minutes and it becomes the lead for the student and you’re just there shadowing. We make a running joke with Mackenzie that there’s times I just fake doing emails or my notes next to the table just to listen and be a part of it, but let her be the one making decisions on what exercises to do or she’ll ask, “What should we do?” I was like, “I don’t know. What do you think we should do?” Just pretend that I’m kind of hanging out here and I’ll jump in if needed. But I think you just slowly give more and more steps each visit and you get a little pocket of five patients or clients that feel more comfortable working with a student.

Mike Reinold:
Right. All right, so Dave, I got a question for you, so how do you draw the line or how do you reconcile giving that freedom to Mack with that, but then also having the patient be like, “Wait a minute, is Dave checking his emails right now?” Cause that’s the real concern here, right? How do you handle that?

Dave Tilley:
There’s one thing of checking emails in the other room, eating lunch, and then there’s one thing sitting next to the table and weighing in and offering thoughts. So yeah, I would say rarely, I’m just in the bathroom for an hour, just letting it ride. But you’re always involved in some way, shape or form. And I think Lenny does a good job of this too. Sometimes he’ll start with someone and then let his student do stuff and then he’ll jump in for some range of motion halfway through or talk about exercises and then circle back. So yeah, you’re never ghosting your patient just sitting there waiting for them. You’re trying to stay involved whenever you can.

Mike Reinold:
I think that’s a great way of phrasing it, Dave, and articulate that too. And I will say in your example right there with Mackenzie too, is she’s been here for a while, she’s been doing a great job. That wasn’t her first eval with you. And one thing we always preach at Champion is we’re never, I don’t think we’ll ever do this, but we’re not the one where the students get their own caseloads and we just check in at lunch and go over what you did that day. To us, it’s about our educational model, it’s you observe then I do, you do, then you do, I do, right? It’s a sequential thing over their 8 to 12 weeks where we’ll do reps of things together, we’ll go back and forth on exams together. So that way we’re both feeling it.

I think it’s been fun. And I’ll say there’s a benefit of that too, by the way, is that the PT and the student tend to talk a lot during that process and then the patient, really, it’s almost like they learn from that experience too. But who else? Dan, I think I saw you.

Dan Pope:
Yeah, for sure. I think one of the big ones, and Dave already talked about this, is you kind of have to choose your patients. And I think Lenny does a really good job of this and me, I’ve struggled with this a little bit because I don’t see students as frequently. So what ends up happening is that you’ll see a patient one-on-one for a large period of time, then all of a sudden you have a student. And if you’re like, “All right, student, jump in, do everything that I used to do,” and that patient’s like, “Oh, I don’t know if I like that.” And that’s not a great experience for that patient, obviously.

So I think a lot of it is A, you have to set an expectation from the get-go. So when the student comes in and starts seeing some of these patients in the diagnosis and you’re getting an idea of whether or not the patient enjoys this experience or not, you can start to say, “Okay, yes, I think that the student would be great to work more one-on-one with this patient.”

But you may have the opposite experience too, at Champion we get a lot of referrals. They’re coming from other patients that are coming from other trainers that are very challenging cases that haven’t had success in the past with physical therapy. There’s a big expectation they’re going to actually see the therapists they are coming in for, and sometimes it’s really just not the best fit to have the student in there right away. But I think over the course of time you can start to leak in some experiences with the student and it ends up being a bit better.

And going back to what Lenny does, I think he does a great job of this. And I think it’s also because he almost always has students all the time. I don’t think there’s ever a period of time where Lenny doesn’t have a student around him, but it’s very much baked into the experience of Champion, right? It’s like when you come in, you’re going to be working with Lenny as well as a lot of the students and they’re going to collaborate and work together from the get-go, basically, that is the experience that people have. So they expect that moving forward and I think it ends up working really, really well.

So I think you have to choose the patients where you think it’s best and probably set up this experience from the get-go so that folks aren’t getting inconsistency in care over the course of their time at Champion.

Mike Reinold:
I love it. That’s always the priority, right? You can’t screw that part up, Dan. I like that. That’s right. So Kevin, what do you got?

Kevin Coughlin:
Yeah, I think I’ll just echo a little bit of what Dave and Dan were saying because I take a lot of the same approaches, but one thing I’ve found helpful is with Claire and when I had Danielle previously, is I share all the patient notes with them so they’re oriented to what’s going on. And then before the session or before the day, I’ll talk to Claire about who’s coming in and what things we’re working on. And I think early in the clinical, if it’s a patient where we’re doing specific joint move techniques or soft tissue techniques or passive range of motion, it’s something we practice beforehand. And then when the patient’s there, I’ll do it first and then I’ll kind of be like, “Hey, do you mind if Claire feels the shoulder and she can get an idea of what’s going on as well?” And they’re usually open to that.

And that’s kind of how it integrates with patients we’re already seeing. And then I think Dave and Dan were talking about when you have a new patient eval, you just ask the person, is it okay, so my student, is it okay if they kind of hang out and try to figure out what’s going on with your back so we can come up with a plan together? And they’re almost always open to that. And there are some people that will say, “I really prefer to work with a therapist,” but I haven’t had that in my experience.

I think kind of like Dan was saying, it is interesting, it does vary therapist to therapist. Obviously, there are a lot of patients that come in and they want to see Dan or a lot of gymnasts want to see Dave, or a lot of people want to see Mike and Lenny. I think the population I work with, they’re a little more open to seeing anybody as long as they feel like the care that they’re getting is great. And I think that’s kind of a benefit of working at Champion is the system we’ve built is we’re all doing similar things and people will be receptive to that.

Mike Reinold:
Yeah, good stuff, Kevin. I appreciate that. And I’ll say too, we deal with a lot of professional athletes, high-level people, and our students work with them and it works. We never have anybody complain, right? It’s actually kind of scary if somebody does complain, you’re like, “Oh, that’s a tough patient.” Sometimes that’s like that, right? But I think it comes down to the therapist to make sure that, again, to come back to the very beginning of this, that they feel comfortable that they are getting great care and that the student is part of assisting us. But that you’re still the one making some judgments and some calls with some questions, but they know that it’s a comfortable experience and it’s pretty good. But… Dan?

Dan Pope:
Yeah, just really quick, I really want to say, and then Mike Scaduto said this in the past, oftentimes patients end up loving the students and it’s a very synergistic thing. So usually I think the experience with the student and the therapist could be even better than just the therapist alone. So I think that for maybe the students or the therapists out there, they’re scared of integrating the students and diminishing their quality of care. I think it can actually go up if you do it well. So don’t be afraid to use students and to improve care with that.

Mike Reinold:
That’s awesome. I love it. Who would’ve thought we get to the point where we’re quoting Mike Scaduto here on the podcast? I mean, is that amazing? But that being said, Mike, I do want to hear from you, Mike. Obviously you were a student at Champion like 10 years ago now, but more importantly, I think you’ve done a great job embracing a lot of the students and doing a lot of work with them here with us at Champion. Just wanted to get your thoughts on this too.

Mike Scaduto:
So yeah, I was going to go from a slightly different perspective. I think as a CI, you really have to get to know your student. I think from the very get-go, you have to know their strengths and their areas of development. You want to set that student up for success. So your first interaction between your student and the patient, I think that needs to be a very positive experience for both parties involved. I think the student needs to feel comfortable with what you’re asking them to do. The patient needs to feel like that student is confident in what you’re asking them to do.

So there’ll be some students that come in with more manual therapy experience and some students that come in with less manual therapy experience. So I think if the student comes in with less experience, your first interaction between the student and the patient, you’re probably not going to have them do manual therapy. Maybe it’s a good time for them to coach them on exercise technique or take them out in the gym and run them through some exercise and let them build their rapport through there.

So I think overall you have to keep the student’s confidence level in mind when you’re introducing a student and a patient. You want that to be a successful kind of partnership going both directions so that the student feels confident working with that patient and you’re not taking them out of their comfort zone off the get-go.

Mike Reinold:
Awesome. Yeah, I like that Mike. And you know what word I like most out of this is confident. When a patient comes to us and they can detect that maybe there’s a lack of confidence or something, that’s going to be very destructive for their building of trust and saying, “All right, do I think that this plan that they’re outlining is going to help me specifically?” It’s all about that.

So a good example, Kaylee and I did an evaluation yesterday and beforehand I was prepping her as we’re doing other stuff. I’m like, “All right, what are you going to do? What are you going to do?” And now I’m telling her about our secrets behind the scenes here, but there are no right or wrong answers. When I was asking her those, she could have said anything. All I wanted her to do was to think ahead about what she was going to do, so that way she would go into the evaluation prepared. Right or wrong, it doesn’t really matter. There’s a million things we can do, but she was prepared.

And then I think the other thing too is anytime that you sense that there’s a stall in the process with the students, or maybe there’s a little… You can almost sense the student’s like, “Hmm, I don’t know where to go next.” That’s where we have to jump in seamlessly and keep going, but also not steamroll that conversation. You have to get back on track. But then that’s where we always try to say, “Okay, what else could we look at?” And it’s like you give everybody a moment to take a step back, take a deep breath, and get back on track. Because if we’re just standing there and saying, “What should we do next?” That’s not a good experience for that person.

All right, before we move on, I want to get some comments from Jonah and from Diwesh on this because we also have strength and conditioning interns. And I think what’s really unique with the strength and conditioning interns with us that I think would be a helpful conversation too is that they come in and we’ve had some people training with us, for example, for years, like a decade, and all of a sudden there’s a new strength intern. So how do you guys handle that and how do you get that interaction with them to benefit? So Jonah, why don’t you start off?

Jonah Mondloch:
I think a big thing I would say with that is that interns can come into it knowing that they’re not expected to know everything. They’re not the first intern, they’re the 12th intern that this client’s met. So it’s okay to say, “I’m not sure on this one” and check in with a coach. And I think that their goal should be building confidence over their 12 weeks or 16 weeks, whatever it is, which they can do that by showing that they’re here to learn and that they here to develop as a coach.

So making sure when there is something you don’t know, that you don’t just pass them along and say, “Hey, why don’t you go ask Diwesh that question,” but go along with the client, ask Diwesh the question together and make it a learning moment for everybody so that the next time you’re asked that same question, now you have a confident answer and you know how to explain that exercise or answer whatever it may be. But just showing that you’re in it to learn and to develop along the way can help gain the trust from the clients.

Mike Reinold:
Yeah. I like that. And I can definitely see where some of our interns can be intimidated by some of our clients. Cause they’re even like, “Wow, that client knows how to do a kettlebell swing better than I do.” Right? So that’s daunting for them.

Diwesh, what do you think?

Diwesh Poudyal:
Yeah, what I would add to Jonah is what I usually try to get them to be comfortable with early on is the human and the person aspect of things. I always tell every intern group, it’s not okay to call clients, “dude” and “man” to start initiating a conversation. Go up, learn every person’s name. Once you can confidently speak to them via name, you can have conversations, whole conversations, then you’re probably going to start earning that human trust before you start earning the trust as an intern strength conditioning coach that can actually help you with exercise. So that’s like phase one first and foremost. If you don’t know names, don’t go attempt to coach them. Especially in our semi-private model where you’re not stuck coaching one person, you could be coaching 20 people in one hour. So that’s super important.

And then the other aspect of helping them integrate a little bit is, and I know you guys do this in the PT side too, but teaching them systems early on. Like Jonah said, everyone’s going to come in with different skill sets early on. We don’t know what one strength intern versus another one is going to look like from a skill and knowledge standpoint. So it’s our responsibility to teach them our systems early on. That gets them equipped to start trying to be a coach.

So the first week we do a big on-ramp period where we teach them all of our basic systems, teach them everything from how to foam roll to all of our ramp and warmup exercises and our structure behind it. And then we’ll slowly start getting them a little bit more advanced throughout our weekly in-services of teaching them our speed agility, power concepts, teaching them our basic movement patterns and strength concepts. And then all this kind of builds upon itself by doing formal education sessions and then challenge them on a daily basis of coaching, but also having conversations on the coaching floor and asking them to start conversation and square up questions for conceptual things that they should be learning on weekly in-services or con ed stuff that they should be doing on the side.

Mike Reinold:
Awesome. Yeah, great stuff. And then I think the only thing I would add to just wrap this up, and this kind of goes with Jonah and Diwesh with some of our more veteran people. Another technique, I guess you can call it, that we do at Champion is, especially with our veterans, is we’ll have the students and I or the students and the physical therapist kind of alternate sets with either manuals or even evaluation techniques, or I do it, they do it. And then we get the patient’s input. And there’s two things that I think happen psychologically here. I do think it’s important and it helps train the students. I say like, “Okay, how’d that feel? Does that feel similar to mine? What do you…? Give me some feedback.”

And our veteran patients, I wouldn’t do this on an evaluation, obviously, right? That seems a little like the wrong move, but with our veteran patients, they almost take ownership in it. They’re like, I’m helping this person get better. And then they never answer at the end saying, “Oh no, that was terrible.” They help calibrate them and they say, “No, that was amazing.” And what the student does is they do get some feedback, but more importantly, the patient is saying, “This is how I… This is right. This feels good.”

So it’s a psychological thing I think sometimes that they take a little ownership in that development of the student as well, and they’re like, and they always step back and say like, “Yeah, that was great. They’re doing a great job.” And then the confidence goes through the roof. It’s a great environment. So something to kind of think about.

So anyway, I think that was a really good episode. I think that was really helpful, hopefully for the students too, because maybe you can go into a clinical setting with some of that knowledge behind your back a little bit too. And you can almost try to do some of those techniques yourself if your CI maybe isn’t doing that. But I think it’s always important to try to get as comfortable and safe as quickly as you can with people just to make sure that they feel confident that they’re in the right hands. I think that’s the key. So…

Awesome. Great question Mark. I appreciate it. If you have a question like that, head to MikeReinold.com and please head to Apple, Spotify, rate, review, subscribe to this podcast so you keep getting notifications when we drop new ones. And we’ll see you in the next episode. Thank you.

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