St George's Physio Blog - 2nd Year

The saga continues!

For those of you wanting to check back, the 1st year thread is here

http://www.thestudentroom.co.uk/showthread.php?t=460341

so you don't have to dig down 300 pages to find it!

The second year doesn't officially start for another few weeks, but I decided to log on to check my email and finally, news had arrived about our first clinical placement. I'd hoped for musculoskeletal, as that was what had originally got me hooked on physio, and if you get it early you get anohter one later, and guess what - I've got it :biggrin:

I'm at the place where I did my observation back in November, and the people there seemed great, so I'm really looking forward to it. Better bury my head in Palastanga and get re-learnign all those attachments and nerve innervations!

This is where it's all for real! Not that we'll be expected to treat people on our own, but it's be fantastic to finally go out into a real scenario and have some knowledge of what's going on.

Reply 1

JackieS

11

iainmacn

The saga continues!

For those of you wanting to check back, the 1st year thread is here

http://www.thestudentroom.co.uk/showthread.php?t=460341

so you don't have to dig down 300 pages to find it!

The second year doesn't officially start for another few weeks, but I decided to log on to check my email and finally, news had arrived about our first clinical placement. I'd hoped for musculoskeletal, as that was what had originally got me hooked on physio, and if you get it early you get anohter one later, and guess what - I've got it :biggrin:

I'm at the place where I did my observation back in November, and the people there seemed great, so I'm really looking forward to it. Better bury my head in Palastanga and get re-learnign all those attachments and nerve innervations!

This is where it's all for real! Not that we'll be expected to treat people on our own, but it's be fantastic to finally go out into a real scenario and have some knowledge of what's going on.

I shall add the new link to the main thread tomorrow :smile:

Glad you got a good placement - but be warned - if you get musculoskeletal for CP1 they usually try togive it to you again in the third year so hope you like it or it'll be hell getting it again lol

Reply 2

jinglepupskye

14

iainmacn

The saga continues!

For those of you wanting to check back, the 1st year thread is here

http://www.thestudentroom.co.uk/showthread.php?t=460341

so you don't have to dig down 300 pages to find it!

The second year doesn't officially start for another few weeks, but I decided to log on to check my email and finally, news had arrived about our first clinical placement. I'd hoped for musculoskeletal, as that was what had originally got me hooked on physio, and if you get it early you get anohter one later, and guess what - I've got it :biggrin:

I'm at the place where I did my observation back in November, and the people there seemed great, so I'm really looking forward to it. Better bury my head in Palastanga and get re-learnign all those attachments and nerve innervations!

This is where it's all for real! Not that we'll be expected to treat people on our own, but it's be fantastic to finally go out into a real scenario and have some knowledge of what's going on.

If you want some advice - even from a failure like me - then don't concentrate too hard on the anatomy and physiology theory. It's not that it isn't important but you would do better concentrating on how to do a good subjective and objective assessment, make a preliminary diagnosis and decide on tests to confirm that diagnosis. Then you need to set out your long and short term goals for treatment. You also need to know how you would monitor the patient's progression and how you will treat them in subsequent appointments.

I think that the major cause of my failure this year is because I got so bogged down in theory and didn't really take it onto the actual physiotherapy side of things. No-one on placement will expect you to know all of the muscles and innervations. They will expect you to do an adequate assessment.

Look at the assessment criteria for the placement and follow that as your guide. If it's anything like ours, the vast majority of it will cover practical things such as completing documentation correctly, being well presented, communication with other members of the MDT, attitudes, practical skills, approach to patients, clinical reasoning, safety and preparation for treatment, discharging patients etc.

One book that I have found very useful in MSK placements is the Pocket Guide To Musculoskeletal Assessment by Richard Baxter. It's become my bible!

Now back to Big Brother and Nicole's eviction interview!

Reply 3

iainmacn

OP

10

Thanks JP - good point - I do have to do it all in practice. I'm hoping I'll be okay, I think I've got a pretty logical approach to diagnostics from my background - I think note keeping might be a downfall though so I need to be careful!

At the mo I love MSK so I'm quite happy to have it again - will be rather sad if I don't get it in fact, but I guess that could change! Seems an obvious one to combine with paeds or orthopaedics or something.

One of the girls got a neuro rehab post neurosurgery placement, which sounds cool as hell! WOuld love to get that

Reply 4

JackieS

11

iainmacn

Thanks JP - good point - I do have to do it all in practice. I'm hoping I'll be okay, I think I've got a pretty logical approach to diagnostics from my background - I think note keeping might be a downfall though so I need to be careful!

At the mo I love MSK so I'm quite happy to have it again - will be rather sad if I don't get it in fact, but I guess that could change! Seems an obvious one to combine with paeds or orthopaedics or something.

One of the girls got a neuro rehab post neurosurgery placement, which sounds cool as hell! WOuld love to get that

I think the other thing to remember is that this is your FIRST placement - they will not be expecting miracles from you and you shouldn't be expecting miracles from yourself either....there will be lots of things that you can't get the hang of and at times it will feel like you're completely pants and will never be able to manage it! At the end of the day, the first placement is pass/fal (at George's anyway) so just try and learn as much as you can from it so you can take your weaknesses forwards onto future placemnt so you can work on them when it really counts.

And jinglepupskye is right, most of the marks on placement go towards many of things you wouldn't think of. Get hold of the mark scheme for the placement (its a generic mark scheme) and look at the times of things you'll be marked on...anatomy, physiology etc only makes up a fraction of the marks you'll get. Obviously its important to know them but there are more important things to know....the sections in the marking scheme all have different weightings toio (it says in the form what the weighting is)

Reply 5

iainmacn

OP

10

Last day of the holidays - but it's no rest for me. We go back for a week and then start on placement, and yesterday I rang up to itnroduce myself and sort out a few details. Plus we'd been given an info sheet which contained a lot of stuff that we ought to be faniliar with. The anatomy and things were no problem, but some of it was stuff we haven't done yet - which I think is pretty common speaking to others on the course. I don't think we're expected to have fully mastered it, just have an idea of them and to know the basics like red flags and yellow flags. Might be an idea to cover these in the first year at George's as they're universally important.

There's a tinge of nervousness - I feel like I've forgotten a lot of detail over the break, but reading last nigt a lot of it was coming back to me pretty quickly. Can't wait to get back and see everyone, meet the new first years, and get out rowing on the river again. I've been doing a lot of fitness stuff over the summer - biking, swimming, triathlon, and some ergs (rowing machine), but not actually been on the river - which is something I love. Quite apart from the camaraderie, there's something relaxing about it as you're so close to nature (so to speak) - sitting a few inches above the river as you glide through it is somehow very chillaxing :smile:

Right - better get back to the books!

Reply 6

iainmacn

OP

10

Firsy day D&D (that's done and dusted, in case anyone thinks I played dungeons and dragons all day!)

It was great to be back, catch up with people, and get stuck into it, but at the same time...

OMG I've forgotten a lot and I'm bricking it!! :woo:

(hmm - why is that smiley called "woo" - I took it to be a panicking smiley)

a quick straw poll revealed that a lot of us felt similarly - excited but nervous!

the lectures were a lot about professional obligations etc - all essential but a bit dull. The rest of the week is spent doign some case studies to help us get back into the swing of things, which should be really useful - only most of us are goign to be hungover from the "Meet the freshers" event last night.

George's runs a "Mums and dads" system so you get allocated someone to look after you/or now we're second years - to look after, which is great as a definite person to show you the ropes but people generally help the newbies out anyway. My offspring wasn't there last night so I just chatted to everyone. Lots of familiar faces from doign the interview days. Very freaky to have to say "I'm a second year" so many times and to think that a year ago I was on the other end of the welcoming speeches from second years.

This year is set to be busy - we put a lot of the theory into practice now and really see it in context. At the moment, even when I've got all the theory sharply in focus again, I'll still be a long way from treating a patient on my own - and this year should help bridge that gap. Many of the components have been covered - this year we add others (lots of special tests) and bring stuff together into a coherent whole. Bring it on :biggrin:

Reply 7

iainmacn

OP

10

The last few days have been mainly about our practice case - which is a good way to get back into stuff. The third years are helping us out as they're more experienced, so it's someone new to practice on too, adn they can give sensible feedback. It's revision (and a wake up call) and also helps to bring everythign together. What's rather lacking for me at the moment is

1) the clinical reasoning - I know the tests we're supposed to know (although some were a bit rusty) but have not yet quite got the hang of putting it all together in to an investigation that has a direction - i.e. coming up with hypotheses and doing further tests as a result of this. Part of that I think is because we haven't done special tests yet - but my lovely third year showed me some relevant ones

2) Actually talking while thinking. Granted I am a bit rusty, but even if I were sharp I think I'd still struggle. In my old job as a teacher I didn't have to think about the subject matter so could talk in a fully engaged way - now the material is less ingrained, I keep speaking but Priya (my third year) said she could tell I was thinking at the same time and wasn't as engaged with her as I might have been. All very true - I could sense I was struggling - but I guess this only comes with practice

I'm not sure what Priya's briefing document said - but she didn't seem to be revealing any symptoms - and although I know the potential hypotheses we were supposed to reach, a) medial problems such as an MCL strain from a medial impact doesn't quite make sense to me (or my textbooks!). Plus I'm not sure whether to treat that - guess I will as the other hypothesis was a medial meniscus tear which might need an arthroscopy, and I'm not able to do those, fun though it might be!

We've also had a session on portdolio building. This is vaguely familiar to me from teacher training days, although not exactly the same, but I know it's going to be quite time consuming - and probably not too popular with most of us who are already going to be busy - but I do think it's an effective tool. You have to maintainn a portfolio once you qualify to show continuing professional development, so the course is ahead of the game in getting us into good habits, even if we do resent it!!

Seen he first years about a fair bit - it looks like they've imporved the first week so there's a bit more going on, or at least it's orgnaised a bit tidier so there's less gaps then for us.

My wonderful fitness regime has rather lost out to study since term started - I piled on over a stone in the first time last time round - must make sure that doesn't happen again! Rowing kicks off again this weekend - will be great to see everyone again down at the river, although I've bumped into a fair few around George's since being back.

Reply 8

ZakBrannigan

13

iainmacn

The last few days have been mainly about our practice case - which is a good way to get back into stuff. The third years are helping us out as they're more experienced, so it's someone new to practice on too, adn they can give sensible feedback. It's revision (and a wake up call) and also helps to bring everythign together. What's rather lacking for me at the moment is

1) the clinical reasoning - I know the tests we're supposed to know (although some were a bit rusty) but have not yet quite got the hang of putting it all together in to an investigation that has a direction - i.e. coming up with hypotheses and doing further tests as a result of this. Part of that I think is because we haven't done special tests yet - but my lovely third year showed me some relevant ones

2) Actually talking while thinking. Granted I am a bit rusty, but even if I were sharp I think I'd still struggle. In my old job as a teacher I didn't have to think about the subject matter so could talk in a fully engaged way - now the material is less ingrained, I keep speaking but Priya (my third year) said she could tell I was thinking at the same time and wasn't as engaged with her as I might have been. All very true - I could sense I was struggling - but I guess this only comes with practice

I'm not sure what Priya's briefing document said - but she didn't seem to be revealing any symptoms - and although I know the potential hypotheses we were supposed to reach, a) medial problems such as an MCL strain from a medial impact doesn't quite make sense to me (or my textbooks!). Plus I'm not sure whether to treat that - guess I will as the other hypothesis was a medial meniscus tear which might need an arthroscopy, and I'm not able to do those, fun though it might be!

We've also had a session on portdolio building. This is vaguely familiar to me from teacher training days, although not exactly the same, but I know it's going to be quite time consuming - and probably not too popular with most of us who are already going to be busy - but I do think it's an effective tool. You have to maintainn a portfolio once you qualify to show continuing professional development, so the course is ahead of the game in getting us into good habits, even if we do resent it!!

Seen he first years about a fair bit - it looks like they've imporved the first week so there's a bit more going on, or at least it's orgnaised a bit tidier so there's less gaps then for us.

My wonderful fitness regime has rather lost out to study since term started - I piled on over a stone in the first time last time round - must make sure that doesn't happen again! Rowing kicks off again this weekend - will be great to see everyone again down at the river, although I've bumped into a fair few around George's since being back.

wow the second year comes around so fast doesnt it :eek:

.Its good that your university has a system in place that second years help and assist the first years who really dont know what to expect with regards to work and so forth.Portfolio building sounds familar to me also.Thats a big thing with any PAM course that even when you qualify you have to go on more courses and update your skills and so forth.I look forward to reading your physio blog :yep:

also good luck with the Rowing as well :biggrin:

I am sure that once you get back into the swing of things you will be fine and it be back once again to the grin stone as i call it.

Reply 9

iainmacn

OP

10

Yeah the way each year helps the others out is great - we had the third years helping us this week and they were great - they acted as models, which was good for a start as we've got so used to practising on each other! Plus they gave us feedback, tips on note taking, and a whole host of other stuff.

Yesterday it was treatment time - so I dug out my notes on electrotherapy, read Brukner and Kahn, and digested Magee plus Petty and Moore. Well -the relevant sections anyway, and went in with a treatment regime. Priya (my third year) made a few tweaks along with a brilliant tip for writing stuff up and we were off. I even had to deal with her acting awkward on purpose - it was more saying "I have to go on my ski trip so my knee must be fixed on time" than anything technical - and I can do people skills like that. A good exercise though - for those who haven't had to deal with that sort of thing before it's a great idea to practice it. I ended the sessions with the thirds years on a high - feeling way short oof an expert but feeling at least competetnt - it had cleared many of the cobwebs! Really up for placement now.

Portfolio is a bit of a drag - but essential - and I've done one before for my teacher training, so while it's tedious, I know what to do (I think), and we had several useful sessions on it which filled the odd gap. We've got today off, some research methods classes on Monday and Tuesday (useful for reviewing papers) and then off to placement on Wednesday :biggrin:

btw - in case anyone got the wrong idea about changing at George's (a tutor mentioned someone had seen something on here and asked about it), we don't have to get changed in corridors - a lot of us just tend to. There are places to change if you need to, or if you're uncomfortable with it for religious reasons then that's all fine too.

Reply 10

iainmacn

OP

10

Yesterday was spent doign research methods. tbh - I think a lot of us rather resented the timing, as I think most of us are really up to our eyeballs trying to prepare for the placement which starts tomorrow, and I nearly didn't go along as I've done RM as part of my teaching qualifications. Still - I went in no small part because the radiographers were coming oevr from Kingston where they've been for the last few months and I wanted to catch up with friends. That was great to do, and the RM stuff wasn't at all bad - I think if I hadn't seen RM before I'd have found it quite a nice way to introduce it, and I particularly liked the group session. EVen so - I think the timing was more for the radiographers and midwives, but I'm sure I'll cope!

Tomorrow sees the start of placement - lots to do still like revise anatomy, toissue healing times, and work out my objectives for the placement, as well as consider my strengths and weaknesses. (Basically a SWOT analysis if you've come across those). I started it last night, and it's rather weird - some of the strengths I thought I brought from my previous career don't necessarily apply - I was confident of my subject knowledge before, so I think I wcould calmly reassure any anxious students/parents and it worked. With physio, although my knowledge isn't bad for someone who's been studyign for a year, I'm inevitably not as confident about it, and that probably comes across, even if I communicate using similar words. Still - I used to be like that with teaching, so I'm sure it'll come over time.

Anyway - got to get into uni - another RM lecture and then off to try and get some plain navy trainers from Primark!

Reply 11

iainmacn

OP

10

Today was the first day on placement. The morning was spent at George's, along with all the other physios stationed there or at one of the satellite centres, going through trust policy on all and sundry. Important stuff, bt rather tedious!

We then had a quick session learning how to use Tiara - the computer system. This isn't for notes, more for appointments and keeping track of our use of time.

An early lunch break, so we had a coffee - met up with the third years and chatted - they wished us luck for placement and off I went to my placement. I have to be careful not to say too much as it all has to be anonymous. I'm at the same clinic as Lucas, who I've studied with a lot over the past year, and it was good to know I wouldn't be there on my own. I think we'll spur each other on too. Odd really - we were both at interviews on the same day, and we both did our first degrees at the same place!

We met up with out two clinical educators, and got a tour of the building and introductions to various staff. We then sat down to go through how to use SOAP notes - this is a system for structuring your written notes. The practice last week at George's was an enormous help, and I think we made a good first impression. L (our first clinical educator, or CE) kept asking us to suggest stuff rather than just tell us, but maintained a really good balance so that we led the discussion but she'd step in if we were stuck. The time absolutely flew by - I looked up at the clock (no watches for hygiene purposes) and it was nearly time to go home.

First patient tomorrow - and I think we're watching Lisa do the patient interview, although we may well get onto doing it for ourselves in the next few days. One or other of us has got a new patient most days, and the other gets to step in too. After each session we have a discussion with one of the CEs who saw the session and gradually take over more and more. We're never let off the lead completely obviously, but it's a acse of giving us as much chance to take ourselves further as they can.

We've had a look at the brief notes for tomorrow's patient - and I need to read up about anterior knee pain and associated tests.

Absolutely loving it so far :biggrin:

Reply 12

iainmacn

OP

10

Well that was a wash out - my first ever patient (if you don't count the one from observation) wwas a DNA - that's Did Not Attend. I did get to see someone else, but I hadn't prepared any hypotheses for that or done any background reading, as it was nother body area. It did give me a chance to see a subjective assessment being done, and watch Lisa go through the steps we'd talked about.

Then it was off to George's (again) for an in service training (IST = must stop calling it INSET which is the teaching thing). It was on the lumbar spine, and fascinating. Practice with some junior physios on some of the basic PAs we'd done during thre year, using boney landmarks to locate vertebrae, and then fancy stuff such as neural glides that we've not covered, but E quickly filled us in on the basics. We were actually told beforehand that a lot of it would go over our heads, and some did, but I got a hell of a lot out of it. It was interesting to see how the junior physios still had a lot to learn - which is good as I want a job where I continue to learn and don't stay static

Then back to our main base where our other CE (V) gave us a run through objective assessment, and went through things like the Thomas test that we don't do until later in the year. We'll have a head start on a lot of the other students in our group.

That was all yesterday (Thursday), and today we got in at 8:30 and took alook at the notes for the first patient. Lucas (also from my year) and I were in with our CE1 for a female patient. Anyway - Luke was "main student" for this one and CE1 asked him if he'd like to do the subjective. He agreed, I decided that meant I had to do a subjective on my patient (I was keen but nervous). It's all a bit of a blur but we ended the day havign both done subjective exams, amd then come up with working hypotheses and suggested tests and treatments. The CEs have been brilliant at gradually gettign us to take on more and more responsibility, and while we're still at the stage of needing prompting and often redirection, we're really playing an active part rather than just observing - and we've only been there a few days!

The other main activity was sorting out my goals for the palcement - and L helped me write those.

The afternoon saw another fascinating case - someone with a fractured patella - so all that stuff on bone healing times came into play with a vengeance, along with all sorts of stuff on gait, muscle length, and various other special tests that we went through afterwards (we'd done some of them yesterday with V).

Really looking forward to Monday - when we start with a person with pain caused by running - so verymuch up my street and we've already kicked a few ideas around for hypotheses and what tests we might do - although as any hypothesis is a working one - that's subject to change when we do the subjective. I say we - it'll be *ME*!! :biggrin:

Just in case anyone can't tell, I'm absolutely loving placement. Every patient brings new tests to do, new bits of clinical reasoning, and new stuff to get excited about. SO far it's everythign I wanted from physio and more

Reply 13

iainmacn

OP

10

Throughout my life I've had a serious of firsts. My first day at school, my first kiss, my first girlfriend, my first degree(!), my first gig, the first property I part owned, my first job, the first time I had sex (not necessarily in that order!). Today I had a new first....

I gave out my first theraband :biggrin:

Now compared to some of those other firsts, this one is relatively small - but it's a milestone. The theraband - those giant brightly coloured giant elastic bands dispensed by physios across the world - is a major symbol of physioship. For one dreadful moment I thought that the patient was going to say she had a latex allergy, and all my hopes would be dashed on the rocks, but she didn't - so with trembling hand I cut the length of theraband from the reel. Woohoo!

It's been a particularly fascinatig few days. Monday my CE suggested I started doing some of the objective assessment - which should have been fine as we'd done it at George's, but this was with a real patient and not just with mates. Anyway - I was all set up for it, then the patient arrived late and all I had time to do was the observation. I rather fluffed the subjective. I'm refining it, and gettign a lot better I think - I guess it's all a bit of a process. The CE's have been great at giving tips on how to structure it, how to phrase tricky questions, and so on.

The afternoon saw Lucas (the other student from George's) and I head to the Wolfson to a chronic pain class. Itw as really interesting hwo they taught patients about pain mechanisms - so they got a rela understanding, and also how patients felt guilty at continually being in pain as some felt they were letting down the family. Sobering stuff.

Today we started at George's - which is the central base and where the in service trainign is done. Today we had knee assessment, which was great as we'd been doing knee cases all week. It might sound boring, but it was a great move by our CEs as it meant we could get to know a joint really well and the pathologies so we could not worry too much about all the other joints and focus on our Subjective and objective assessment skills. It's also a very common one in outpatient physio.

ANyway -the lead educator was off sick, so we worked through her handouts, helping fill in gaps within the group. We were in with juniors, but even so I was surprised at the gaps in their knowledge that I knew - perhaps partly because I'd been studying it a lot and some had switched from other rotations. I guess that can be an issue when you switch areas - I know I've forgotten lots of anatomy over the summer break.

Then back to the clinic to see a patient - L let me do more stuff on my own - including putting together the treatment plan without talking it through first - which was cool - and led to my first theraband!! I think my clinical reasoning was better as my main hypothesis seemed to maych what she was thinking, and the main tests to do during the objective were pretty much what I expected, although we might have disagreed on the minor detail - I was in the right area. I'm loving the way I'm gradually being encouraged to do more and think more for myself, while always knowing that there's a safety net there. IMO she's struck the perfect balance - enough back up so we won't stuff up, but not wrapping us in cotton wool so we get to try loads of new stuff. V, the other CE is fab too.

We ended the day with a back fitness class - more of the holistic approaqch, and rather fun to do. Lucas and I get to take it next week - should be great :biggrin:

Reply 14

iainmacn

OP

10

Two more days on placement, and every patient teaches me something new! We've also had some interesting education sessions on knee treatment and special shoulder tests, so I now know loads like Neer impingement test, load and shift, Hawkins-Kennedy, empty can etc etc. They're all beginning to blue. Our other clinical educator, V, showed us how to tape for protracted and raised shoulders, which was rather cool, and one of the other physios showed us how to do various tapings on knees. They're all enormously helpful, roughly half are pretty experienced and the other half are graduates from the last few years.

It's a hlaf day today and I start next week with an elbow patient - with a fractured radial head (must stop calling it Radiohead, although if Thom Yorke is after an enigmatic title for the next album, "#" is my suggestion (makes as much sense as Sigur Ros' "()"!)). Hmmm - punctuation overload in that sentence! Good job I used to be a computer prgrammer and naturally match up brackets!

My patient today was a minor triumph - in that I managed to get the subjective assessment under 20 minutes, and also pretty well structured. The only thing I forgot was unexplained weight loss. Lucas remembered it with his patient, who said "well I lost loads of weight when I had dysentry". True - but hardly unexplained! She was the first shoulder patient we've had, so the first "top off" embarasment moment!

Talking of confidence, it makes a lot of difference in patient comunication. My patient today had had pain but I couldn't find anything specifically wrong with her in the time available, even though I managed to do quite a few tests. I discussed it with L(CE) and we produced a spiel to reassure the patient, but somehow because I didn't say it with enough assurance the patient lost confidence and started asking more questions. L basically said the same speech but because she was more confident about it (and possibly her status too!) the patient believed it. I guess I knew that anyway from teaching at parents' evenings - say it with enough assurance and parents won't dispute it - say it tentatively and they will. That's somethign to work on.

This coming week, as well as boosting my anatomy/special test knowledge, I'm goign to work on refining my subjective and then my clinical reasoning to my musts, shoulds and coulds. i.e. getting the right top hypothesis and producing the most important tests. I can still develop treatment ideas but they're coming on pretty well, and tbh I think the clinical reasoning is progressing pretty well - it's just that new scenarios (almost every time even though we have had a lot of knee patients) will throw me.

Reply 15

jinglepupskye

14

It sounds like you're having fun on placement. :smile:

Although you need to know the tests to confirm a diagnosis, I've been told several times that most of the info comes from the subjective in MSK outpatients. Obviously it takes practice (and time) to be able to diagnose mostly from the subjective, but it's worth keeping in mind.

Half days are the best thing ever invented! Personally I think 'top-off' moments are when you have to be at your most professional, because if you aren't confident then the patient won't be either. If you just approach it in a calm, no-nonsense, professional manner then the patient will be reassured. Obviously don't be brusque or demanding, just ask nicely as though women taking their tops off for you is nothing new, and nothing to bat an eyelid about - professionally I mean! It's the same with reassuring people, I've said stuff not very confidently before, but when my CE said it they were happy as lowies.

I wouldn't worry too much about new situations throwing you, just go back to basics. You know what is in and around the knee joint - bone, menisci, bursa, ligaments, muscles - so relate the location and type of the pain to what could be causing it. Also what makes it better or worse. Resisted movement eg stairs will probably hurt more in muscles, whereas a clicking sensation may be meniscal, or weakness could be ligaments mostly, or meniscal or muscle. Simple! :p:

Listen to the symptoms, and question them further, if there is a painful arc in the shoulder - impingement, though most people you can't get a true arc out of them, because once the pain comes on they won't let you go further. I digress. Knees giving way, find out if it is true giving way, and you'll be closer to a diagnosis.

Anyway! I've rabbited on long enough. Hope some of this is useful, if not to you then to others.

Reply 16

iainmacn

OP

10

yeah that's all so true - a few days ago we watch a physio who was quite a bit older - at a guess 25 years+ in the biz - and she was so matter of fact about trousers off (the woman hadn't bought shorts and couldn't roll them up as we needed to look at her hip) that the patient just did it.

I guess as a male I face a wee bit more of an issue with it than a woman, but I still think if you're not on edge about it then the patient is more relaxed.

I'm not sure the whole diagnosis thing is simple - although it may get to feel that way in future! My CE said "it's about the whole picture, not one test". While one test can give a big clue, it's when I have to see the one key tree through the woods of insignificant twinges that I get thrown. I guess as you gain experience it's less of an issue. The patient this morning was possibly bone bruising, which I hadn't really come across before. I did my best subjective yet, after a chat with the CE tried lateral and medial glides and palpating under the patellar. Patient had same pain superior to the patellar - I suggested quad tendon tendonopathy but the CE seemed to think that wasn't that likely - but then she's more experienced.

I think part of it is that having being at a high level (I wouldn't exactly say expert but certainly pretty high up) in my old job - it's weird to suddenly be back as almost a novice. Still - in many ways it's the learning curve that excites me - plus the fact that I'll be learning new stuff even once I've graduated (at a hell of a pace I think!).

What's also rather good is that a lot of the staff trained at George's, so we've been swapping tales!

Reply 17

iainmacn

OP

10

oh yeah - and I've learnt a lot about weakness! Muscle strength can be influenced by so much - not just the muscle and innervation (which I did know) but also by pain making the patient not try too hard (fair enough) but also by effusion. Apparently 5ml effusion can really impair VM strength significantly

Reply 18

iainmacn

OP

10

okay - I've changed the clinical educators to V and L - had a look in the student handbook and it does say to maintain anonymity of educators as well as patients - thanks for the tip off JP :smile:

Anyway -the patient mentioned above was a no show for her follow up - which was a shame. It might not have been anything my explanation the previous session, I've learnt in my past job not to take things personally, although I do still think I could have done things better. A lot of patients haven't turned up this week, including some for very experienced physios, so it's all part of the job!

Spent the afternoon with S - another physio who's been qualified for over ten years. Saw some really interesting patients, including a shoulder impingement case, plus a post-pregnancy lumbar spine pain one which is quite a standard. Lots of lifestyle advice on how to carry out activities without stressing the spine as well as strengthening stuff.

Today I saw another knee (knee patients become "knees", for some reason) - and while I know there were mistakes in there, I pretty much drove it through from start to finish with very little need for intervention from the CE - other than to confirm what I was saying and a wee bit of help on clinical reasoning. I now know the knee pretty well (nothing like the CEs, but pretty well) and so things went pretty smoothly. COmpare that to the previous day when I struggled with a suspected radial head fracture (I'd studied this in detail over the weekend) which suddenly turned into a wrist as that's where he was getting the pain. I don't know the anatomy that badly, but it's a complex joint and I ended up making a pretty big stuff up of it - measuring angles wrongly so the table got in the way of the goniometer - not good! I recovered most of it but even so it wasn't one to be proud of, whereas today I felt pretty much on top of it.

I was due a shoulder patient this afternoon, and I'd researched a rotator cuff rehab programme, but then the patient cancelled as the problem had got better. I was cursing! I thought i was going to get another ahoulder impingement patient later, but things were shuffled round a bit so Luke saw him - which was fine as I got to watch and so still learnt a lot, and V asked Luke and I questions (we usually let the main physio for that patient have a go at answerign first), so I could think through the clinical reasoning too. I knew which tests to do, although I didn't get to actually try doing the tests - but I expect to get some more shoudlers over the next week. I've a wrist in the morning, so I need to mug up on that anatomy, plus of course palpation, accessories, treatment, etc. I've got a fair idea but it needs to be pretty slick - particularly where there's a lot of anatomical bits and pieces, it's good to be able to visualise the anatomy under the skin as you're palpating - another reason I like the DR as you can see it all in 3D.

We finsihed the day taking the spinal fitness class - C who normally runs it introduced us and then sat back as we took pretty much all of the rest. In many ways that felt the most comfortaqble - I know the exercises (from the gym as well as physio) and I'm experienced standing up and explaining stuff to a group from my old job.

Thursday sees my half way review - while I know I've still got a heck of a lot to learn (even physios qualified for two years have), I feel I've made a lot of progress. The CE's know that we come to the placement not havign done lots of the tests so we won't be expected to know them, but we've been very keen to learn them and I hope I'm reflecting well on each session. I certainly feel that I've got an awful lot out of each and every session so far - even if I'm watching Luke.

Reply 19

iainmacn

OP

10

Right - had my halfway the other day - CE was really great and we talked through how I was doing (high 2:2 - which doesn't seem good but that's rated by the croteria for the whole placement and she expects me to get that up quite a bit in the remaining two weeks, and gave me some tips for doign so. All really productive.

Main things I need to work on is just generally gettign smoother - not moving the patient to one position and then to another whereas by changing the otrder of stuff round I could be a lot slicker. Time keeping needs to improve a bit - and has already started to. Generally speaking though most of it is just getting used to working in a real world scenario and will come with more practice.

The only donwn side is that I only have two weeks left of the placement. I'm sure we've got some good stuff lined up back at George's, but I'm learning so much on placement that I could happily stay longer!

St George's Physio Blog - 2nd Year

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