Welcome to our first blog for professionals! This guest blog is written by my student, Jake Kelso, SPT. As of Friday, he ceases to become and student and will have graduated from PT school- the final hurdle being only the board exam to get his license.
Rather than do another semi-useless in-service, I tasked Jake to write on the hardships of PT school, the lessons he learned, and how all clinical education experiences are not created equal. This is what he gave me...
Howdy. Are you ready for pure gold in blog format? Because that probably isn't what this is… but being a DPT student at the end of my final week of my final rotation EVER, I may or may not (but definitely do) have some nuggets of knowledge I’m about to drop on your face. My name is Jake, Chapman University Doctor of Physical Therapy Class of 2017 and I’m about to tell you a story all about how my life got flipped, turned upside down.
Quick back story- I graduated from high school in Arizona in 2008 and graduated from Arizona State University in 2012 but didn't give much thought to what I wanted to do with my life until about 2 months before graduation. I wasn’t ready to enter the job market yet, I didn't feel like I knew much of anything, and I absolutely didn't want to begin a dead-end career working up the proverbial corporate ladder into the vast abyss of unhappiness and despair that is… a boring desk job. I don't have the classic story about tearing my ACL in high school, going to PT for rehab and falling in love with it. I am a much more logical person than that I did my research. As my undergraduate education was drawing to a close, I looked desperately into graduate degree programs that tickled me intellectually and sparked my passion. Physical therapy stuck out (surprise right?) but I wasn't completely sold. So I read… and read… and read… andreadandreadandread about the profession, eventually deciding to get a job as a technician at a well-known physician-owned orthopedic practice, and begun the $10/hr journey of my life.
Unfortunately by this time, I had graduated from ASU and upon looking into the requirements for PT school, realized I was a good 30 credits short of what I needed to get into just about any PT school. Fortunately though, I was now motivated more than I had ever been during my 4 years of undergrad to kick absolute tail in my classes and when I finally applied to 6 graduate programs a full year later, I was rocking a whopping prerequisite GPA of 4.0 and overall GPA of 3.9 (my type-A personality was so disappointed by this if you can believe that).
In January 2014 (pretty sure it was January 3rd if you really want to know), I got the email from Chapman saying I had been accepted. FINALLY! Interestingly, I got an email a week later from Midwestern and Northern Arizona asking me to attend interviews for their schools as well. The interview with Midwestern went well- a month later I found out I got in. NAU wasn't so hot (Get it? Because the school is in Flagstaff…). I didn’t get in but was waitlisted, and it was a slight shot to my ego.
It was time for a decision to be made. Stay in AZ and go to Midwestern? Head to California and attend Chapman? Or hold out for NAU, waitlisted at #26 and a long shot, but a much cheaper long shot than the other two. I chose Chapman (surprise again right?) and moved to Cali because when is there another time in your life when you’ll be able to up-andmove to a different state and essentially start an entirely new life? I decided it was that time in my life. Three years and a lot of coffee/Redbull/Monster later, here I am writing this story and reflecting on the things I’ve learned in the process and wished that someone had told me. Or maybe they did tell me but I wasn't paying attention right? I’d like to share these with you. Here comes the meat and potatoes. Buckle up.
1. Apply for early admit.
I worked for Chapman DPT grad admissions part time while in school and I think 1600 people on average applied per class to the program. About 16-20 applied for early admission (who had met the minimum requirements). They all got into the DPT program. So meet the minimum requirements and do it. Then when you get in…
2. It’s just school.
First things first. PT school is very doable. There are long hours, frustrating professors, lots of studying, tedious assignments, and more studying… but at the end of the day, it’s just school. Stay focused, set goals, and stay ahead of the game. Semester one was easily my favorite semester and the most enjoyable. Ask any of my classmates what they thought of semester one and they’ll probably start dry heaving. What’s the secret then you ask? See the first sentence of this paragraph. It becomes overwhelming very fast if you approach graduate school the same way as undergrad, studying a few nights before the test, cramming, and having unrealistic expectations of your mental capacity. My advice, chip away at the load and it’ll be much easier. Studying in your apartment jacuzzi with a cold adult beverage definitely helps. Having said that, you aren't going to die if you get a B on an assignment, something I, and many of my classmates, had a hard time accepting. No one in the clinic is going to ask you what grade you got on your second anatomy quiz. They are going to ask you two questions that you had better get very good at answering (courtesy of Dr. Steve Ferdig, PT, DPT, OCS).
3. “What’s wrong with me? And how long until I’ll get better?”
This is what your patient wants to know day one and if you can’t answer this by the end of your exam, they won’t be coming back. Scary right? It’s really not though. The tricky part is explaining it so they understand and can have an intelligent conversation with you about it. If they can’t, that’s on you not them, and you better try explaining it again until they get it. Full disclosure- I still don't feel entirely comfortable answering this question 100% of the time and explaining it in terms they understand. If I could go back to my orthopedic classes, I would have written these two questions on the top of every page of notes and made sure I could answer it for every single pathology we discussed in class. Having said this, I think it does require a certain level of experience to answer these 2 questions effectively. Again, if I could go back to my first clinical rotation, I would have asked my CI these questions after every patient we saw until it was drilled in my head. I still wouldn't be an expert though, because there are so many variables at play whether regarding co-morbidities, psychosocial factors, etc. and this truly is a skill that needs time to develop. So don’t fret children. It’ll be okay. But since we’re talking about clinical rotations…
4. You will have good and ‘less good’ clinical experiences.
I was fairly lucky with my rotations in that none of them absolutely sucked. There were definitely ones that were better than others but everything’s a learning experience, right? Chapman did this thing where they had a couple preclinicals to sort of get your feet wet in trimester 3 and 4. These were two weeks long each and consisted of primarily documentation, occasional hands on techniques, and beginnings of exercise selection. Then in trimesters 5, 7 and 9, you start getting hit with your favorite 2 questions (see above) and everything gets real.
My first rotation wasn’t bad, but there were definitely some speed bumps regarding communication with my CI, butting of heads, and tongue biting, likely by both of us. The part that really frustrated me was the CI-student dynamic, which to me felt more like teacher-second grader dynamic. This probably had to do with me not establishing expectations of my CI ahead of time (epic foreshadowing happening here) and vice versa, poor communication in general, and a learning curve of how clinical rotations were to be conducted.
The second rotation was a little different. My favorite CI-student dynamic was still there but I was better about communicating what I expected from my CI, gaps in my education to that point, what I was and wasn’t comfortable with, etc. and things went a little more smoothly. Side note, she was an NCS and intimidated the crap out of me with her neuro knowledge.
Trimester 9 actually consisted of 2 rotations for me. The first was at a skilled nursing facility, which counted as my acute rotation, and to be perfectly honest, I was NOT excited to go. So many horror stories about SNFs circulated around Chapman, and if we’re being honest, who actually goes to PT school with the intention of working in a SNF? Surprisingly though, IT WASN’T THAT BAD. The staff at this place was so warm and inviting that it made it all worth it. This doesn't sound like a big deal but it came into play around week 4 or 5 of the experience.
I had been working with this patient, we’ll call him John (silly HIPAA). I’ll paint you a picture as best I can. Imagine a 6’ 4” 300-350 lb. man in his 60s who had had a stroke, was physically intact, but had the mindset of a child around 6 years old. And he perseverated SO hard. Everyday I saw him he would tell me “I’m scared, I’m going to fall, Jake.” It didn't matter the difficulty of the task we were doing, how many times we had done it, or how much safety/ support he had around him. “I’m scared” was his favorite thing to say. I tried reframing, I tried changing the task, I tried distraction, I tried to establish mastery of tasks to give him confidence in previously learned skills (heck yes, motor control class what up!) but none of it worked. I think there were also problems on the homefront but we won’t get into that.
As time for discharge approached, his fears became more pronounced. He would visibly shake at the thought of going home. “I’m scared I’m going to fall Jake” turned into “ I want to die, my life is over, I’m going to kill myself.” PT school did not prepare me for this. To be fair though, this is a little outside the PT scope anyway. I informed superiors, documented, and got appropriate services involved per protocol. The discharge team made so many efforts to get him sent to appropriate psychiatric facilities that would be able to take better care of him than we could and definitely much better than he would be taken care of at home, but unfortunately he was denied.
The day came when I had to say goodbye and I made it a point to walk out with him and give him as much support as possible as he got into the passenger seat of his wife’s car, uncontrollably shaking from head to toe. I realized at this point I cared about him probably more than I should have.
This was the last time I would see John. Later that week, I learned John had gone home, gained access to one of his rifles and shot himself. He died in the hospital.
The reason I tell this story, is to stress the importance of having mentors, co-workers, and friends that support you in a facility where things like this can happen. My CIs went above and beyond to ensure that I was okay. Case managers pulled me aside to talk, making sure I was okay. Others simply had kind words or were there to share in the sadness so I didn't feel it alone. I’ll never forget John, and I’ll never forget these people. Believe it or not, I think I’d actually like to go back and work there after I graduate, at least on a part time basis. These people made it all worth it.
Alright shake off the feelings because my last clinical (the one I am a week away from finishing!) was by far the best, hands down. I had most of the kinks worked out, I knew what to expect, and I had a bomb CI. This dude knows what’s up. Eric has a way of explaining concepts in a way with so much patience that was unlike any CI I had in 3 years. The best part- that pesky CI-student dynamic vanished. Sure, he would teach me, give feedback, practice skills with me, etc. but it was in such a non-threatening way that for the first time, a clinical rotation was actually fun! I looked forward to going to this clinic, coming up with goals each week, working ten hours days, and hearing his take on various concepts that came up. The highkicking contests, bowtie Fridays, and ridiculous constitutional jokes about second amendment rights to bear arms (a reference to the tattoo on my arm) definitely made things more enjoyable. There are so many clinics that are so uptight and serious, I was so astounded that there was such place that knew the balance between joke-time and be-serious-time. I’ll never forget this rotation either but for entirely different reasons.
5. Establish expectations + meet expectations = success
Life lessons brought to you by Eric. If there was one thing I took from this current clinical rotation, it’s this. Establish the plan with the patient ahead of time, deliver on that plan, and trust is instantly established. No matter how small or large the expectations are, notifying the patient and delivering on them is like magic Harry Potter has never seen. Even better, this applies towards all aspects of life whether speaking with potential employers, building friendships, or selling yourself in any aspect of life. I didn't believe it until I saw it in action and it’s super easy!
6. Handle your relationships.
If there was any advice I didn't take seriously that I was told before I entered PT school, it was this. While I was telling my life story at the beginning of this post (that I am now realizing is much longer than I expected), I failed to mention that when I decided to move to California, I had a girlfriend of about 2 years, who I was very much in love with. When I told her I got into school and I was going to California, I also told her that I couldn't ask her to go with me. Don't get me wrong, I wanted her to come, but to ask her to pick up her life and leave her home for three years for me seemed incredibly selfish. Fortunately, I didn't have to ask. She said she would come.
When we got to California, we were all each other had and it was extremely hard. We felt isolated because we didn't know anyone at this point, but our relationship grew strong together consequently. As PT school commenced and I got caught up in the minutia as I tend to do, things began to change without my realization. Slowly the dynamic transformed. Over the course of three years, the dynamic changed, we developed different interests, and quite frankly, we changed as people. Our relationship was a plant that we failed to to take care of for three years. There were times when we would water it- we got Disneyland annual passes, took some fun trips up the California coast, etc. but it was slowly dying and I never realized it until it was too late. I didn't handle my most important relationship and it didn't survive.
This trend carried into other relationships too but not to this extent. There were friendships in Arizona that suffered and relationships that fell apart. I was busy, they were busy, we changed as people, I’m sure you know how that goes. I was learning so much at school and was so invested, but I never stopped to think that school and learning would always be there. These people should have had a bigger priority in my life. If I could go back, I would have done this differently.
7. You will feel unprepared when you graduate. Accept it.
There is no possible way that PT school can cover all the material you will ever need in your career and prepare you for every patient you will ever see. School teaches you how to think and it teaches you how to continuously learn. It teaches you how to be critical of information but also to accept that there may be multiple correct answers, possibly a best answer. My advice? Take continuing education courses (especially while in school, they’re cheaper). Stay hungry for information. Make PT your passion. Accept the ambiguous and learn from it.
8. And finally… PT school really is what you make of it.
You can probably get through it a little more passively. You can probably get through it without networking and making connections. You can definitely do the minimum, scrape by, and still see changes in your patients. But why bother? I’ve got one more week left as a student and then the next adventure begins. These are simply some of the things I’ve learned in the past 3 years. Hopefully this post was relatively interesting, possibly insightful, and maybe even as much a pleasure for you to read as it was for me to write. I hope you are able to take something from this and apply it to your own life, particularly for those of you future DPTs. Feel free to email me with your thoughts at firstname.lastname@example.org. Lets chat.
Jake Kelso, SPT Chapman University Class of 2017
Who is Eric?
Eric is a working physical therapy business owner and full time therapist and clinician. He's been through it all. If you're looking for realistic tips, tricks, support, and a community of like-minded professionals and students to help grow with- this is for you.
It is my goal with this group to pass on my knowledge of business, clinical skills, marketing (Facebook, Adwords, and more!) and life stories to help those wanting to grow their self skills, their business, or simply be part of a community of learners and leaders. Welcome to Sockdolager Wellness Company.
Eric is a Physical Therapist who owns his own clinic in Chandler AZ. He is the author of Breathe Better, a father to 3 awesome kids, and a husband to Ashley who is also a physical therapist.