Reflections on the acute care clinical

willamette

 I’ve been at Oregon Health and Science University (OHSU) Hospital since January 5th – if you are going to intern here and don’t have friends or family in the area, check out Phi Beta Pi, a medical student co-op from which I rented a room).  I’ve mostly been on the trauma and medical ICU’s, but had exposure to Neuro ICU, Cardiac ICU, Ortho, and General Surg.  I thought I would take a moment for any students out there to write my thoughts on how to survive and thrive (my situation is apparently pretty unique – most students don’t start out in the ICU’s – but the ideas would be the same regardless).  This is a great hospital and a great group – I’ve worked with one CI specifically, but had the opportunity to work with four or five others in the course of 11 weeks.  And the views are great and the city is fun when you have a moment!

To hit the ground running (thanks to those who gave me pointers before I started):

  • Be familiar with what the lines and tubes are for.
  • Learn to do a quick but thorough chart review.
  • Treat your nurses well – they can give you insight, unhook things, and even help out.  Putting them behind the 8-ball in getting the patient back to bed will make them unhappy.
  • Develop an evaluation style that is yours but encompasses what you need to do as a PT.
  • Have a plan before you go in, but also have two back-up plans – forward and backward progress.
    • Don’t forget what you might need for those plans – socks?  chair?  O2?  Walker?  Extra gown?
  • Organize your lines quickly (hint – find the shortest line).  And talk to the patient (not yourself) while you are doing it to get the history.
  • Keep it patient-centered.
  • Be Confident.  Take Control.  Keep them Covered.  Guard them Close.  Think about discharge plans.
  • Rarely do things go as planned, and you will forget to do something.  These things apparently not only happen to students, but also to PT’s on acute care.
  • Watch vitals!

General thoughts on learning from and working with your CI (works in any setting obviously):

  • Be clear about your learning style.
  • Write weekly goals together, and chart on those as well.
  • Be able to take feedback well, and incorporate it.
  • Be able to give feedback, or to offer an honest opinion (so long as you have a rationale).
  • If you don’t understand something, say so.
  • If you need help, talk to your ACCE.

I’ve liked aspects of both my outpatient rotation and my acute care rotation.  For outpatient (the clinic for the local urban public hospital), I liked the diversity in the clientele and diagnoses (more than just ubiquitous back pain, and working in the ED one day a week made it more interesting).  My CI there was a very experienced manual therapist and I got to see and do a lot – it is great to see what a difference a little manual therapy can make.  In a similar manner, the diversity of diagnoses here has been interesting as well, and my CI is very experienced in the ICU so I learned a lot.  In outpatient you move fast (30 min tx), in acute care you think fast.  In outpatient you see the patient over 3-12 weeks depending on diagnoses, in acute you see the patient one time to months on end (with most being a few days).  Were there things that I didn’t care for?  Sure, but I think that almost everyone experiences that – maybe not right away, but eventually. 

So I have one day left (and the CPI), and I’m glad it is almost over.  I want to go home – to my wife, to a shower/ kitchen/ TV that I don’t have to share with 23 others, to my neighborhood, to my friends.  I’ve learned a lot, but it is time to move on to the next internship – which is close to home.  No more Amtrak for me for a while.  Now off to a coffee shop to fill out the CPI.

Picture credit – willamette, originally uploaded by Jami Dwyer.

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2 responses to “Reflections on the acute care clinical

  1. Pingback: A post for students « PT for Boomers – and beyond

  2. Pingback: Internship tips for PT students | PT for Boomers – and beyond

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