Empathy vs Sympathy

I got this video from my favorite blog, Cup of Jo.

I am guilty of sympathy. I'm going to work on expressing empathy in my personal and professional life. A beautiful video about it.

I love Khan Academy

I once took a college physics course with a professor who barely spoke English. Physics was hard enough in high school. However, I still got an A in the course. I thank Sal Khan from Khan Academy. He is the sole reason for my A.

If you are having trouble understanding physics, chemistry, physiology... etc. Check youtube and see if Khan Academy covered the concept. The narrator really knows how to break down concepts.

I just watched this video about the Sliding Filament Theory to brush up on my physiology for my comprehensive exam.

Community

2 of my girlfriends gave up their profession to go back to school. My #1 advice to them was make friends in your class. My professor said early on in the program that the curriculum does not grade on a curve. Therefore, it does not benefit you to do better than your peers. So make friends...study in groups.

My class took it to the next level. We built a community. PT school is intense and we lost a few souls in the first year but not after that. I really think its because no one wants to fail out and join another class. We all joined a Facebook group so we can post things that might be helpful to each other - study guides, online resources, info from an email that a professor sent to just one of us. Then people started having house parties and birthday gatherings and invited the whole class. After a tragic practical exam, someone would post something hilarious from this #whatshouldwecallptschool. Then there's that class that we are all freaking out about and someone posted a time & place to meet to get extra practice in before the next quiz. Its hard to be alone in our class. Its probably my favorite thing about being in PT school.

Picture of the TV show cast of Community from Sheknows.

Rehabilitation Measures Database

Rehabilitation Measures Database describes a bunch of tests used in the PT setting. Its just a nice resource. Sometimes the tests are presented differently in different classes so I compare my notes to the database to get another party's perspective.

Picture of 6-minute-walk-test from Dr.Pinna.

Mad Skills Exercise Encyclopedia

It looks kinda awesome. I think I might buy the Mad Skills Exercise Encyclopedia.

I'm not an athlete and the idea of treating one kinda scares me because I'm not really familiar with sports. So I always wonder and ask in class what type of exercises would be good for a high-level athlete/person. The answer is always...it depends. Though I understand why my professors say that and treatment prescription should be very individualized... sometimes I would just like a sampling of what kinds of exercises are out there so I have a starting point. I still remember when I figured out how important bridging is. I'm going to check this book out.

Picture from Cool Hunting.

Things to do first thing in the morning...

I was glancing at this article on yahoo that I can't find now... about things that productive people do first thing in the morning. I don't remember the list but here are two things that stuck out:

1. Do the thing that you really don't want to do [its also probably the most important thing that needs to be done]. For me, right now it is an assignment where I have to discuss the theoretical framework behind one of the Healthy People 2020 objectives... yeah, exciting *hint of sarcasm*. The idea is that once its complete, the day already feels like a success because you got that "thing you didn't want to do" out of the way. This leads me to the second item on the list....

2. Exercise - I have a hard time getting myself to the gym. But if I get it out of the way first thing in the morning, I consider my day a success. Also I get the benefit of riding on my endorphin high for the first part of the day.

Stretching Picture from Huffington Post.
Exercise Picture from FitSugar.

How to gracefully fail an exam....

Last week was midterms week. I think that I failed an exam in my clinical decision making class - this class puts all your academic work into context and determines if you have a rhyme and reason to how you treat....and I think that I failed the exam. (Please note: I'm not one of those horrible people that say that I think that I failed an exam and get a 89. I stare down people like that.)

This post is not about how destroyed I feel but more about how to fail with grace. Because soooooo often I see students get really ugly when they do poorly on an exam and it actually works against them. Though, I can acknowledge that it feels good to complain for about 5 minutes but not longer than that.....here are my tips/thoughts.

1) Don't piss off the professor with your complaints. More than likely, he/she will be your professor again.

2) Don't use the words "not fair" to describe the exam to your professor. You sound like a child. Be a little more specific like... it wasn't covered in the 9/20 lecture or that was not my interpretation of the material, my interpretation was.... etc.

3) Think about how you could have prepared better. A test is as much about performance as it is about a learning. Learn from your mistakes. Nothing you can really do about your grade now but you can affect how you approach the next exam. Figure out what type of questions that the professor likes to write - critical thinking questions, short answer, lists, fact-based etc. and adjust your study habits.

4) Figure out what you got wrong and analyze what type of questions that you are not good at and adjust your study habits. Are you getting the fact based questions wrong, maybe you need to study with a partner and ask him/her to test your knowledge. Are you getting critical thinking questions wrong, maybe you need to go to office hours to see how you can get on track or talk through your answers with a classmate [make sure you are doing the talking].

5) Document the above so you see the pattern of questions that you are successful at and what you need to work on.

6) Don't gossip with your classmates. The walls have ears. And everyone hates a gossip. It also creates a negative sentiment amongst your class and then you-all become convinced that your professor has a personal vendetta against you. At that point, you will never be able to learn from that professor again.

7) Be proactive about the end of the semester review/feedback form. If the professor is truly to blame, he/she will only know what the problem is if someone writes about it.

With that said, I stewed last week but I'm back on track this week and figuring out how to do better on my final so I can pass the class..... Wish me luck!

Stink Eye Picture from Bookish Thoughts.
Crying Child Picture from Looks Like Good Design. 
Gossip Ruins People Picture from a Happy Lass.

Treatment Planning Worksheet

I was at my second clinical affiliation this summer and I thought that I was doing an awesome job. During my fourth week in, my supervisor went on vacation for a week and a half and I was handling a full caseload by myself. My professor was coming in the following week and I convinced myself not to be nervous.... I was such a fool.

Basically, my professor pointed out that all I was doing was following orders. And that I did not go to school for $40K/year to follow someone else's treatment plans. My job was to assess and guide treatment based on patient presentation and my knowledge. The key thing that I got out of that painful experience was that... a treatment planning worksheet was in order!

See my treatment planning worksheet.

Name: ________      Week: ___________ of ______________    Discharge Date:___________

IMPAIRMENT/FUNCTIONAL LIMITATION	GOAL	INTERVENTION	REASONING

***Please note my disclaimer - this is my modification of the tx planning worksheet presented by my professor. This is NOT the only one. This is NOT the best one but the one that worked best for me during my second clinical rotation.

Here is my reasoning:
- Impairment/functional limitation column reminds us of patient presentation and to tease out the problems that is within our scope of practice to identify.
- Goal column reminds us what we are working towards.
- Intervention column- includes patient position, therapist hand placement and technique if you want to get fancy. More details, the better. It means you thought it through.
- Rationale column is a reminder that you should be doing the activity for a reason. I know this sounds like a "no-doh" but you see how quickly you get into the habit of "ambulating" with a patient as a form of therapeutic exercise.  In this column, you should consider the stages of motor control (mobility > stability > controlled mobility > skill) and how you are sequencing your interventions. Have you reduced the pain & inflammation so patient can do the full range of motion without squirming? Does the patient have the ROM... to do the motion? Does the patient have the core stability to maintain their trunk while doing the functional activity?
- Week x of x is to meant for the prognosis and present week. If you said that the patient will be able to complete their goals in 4 weeks and you notice that you are on week 3 of 4, you better be 1 week away from completing those goals! Its really a reminder to re-assess as you go along your treatment to make sure you are on track.
- Discharge date is a reminder of when you stated that patient will reach his/her goals.

You can add more columns but I like the four columns because its manageable. I feel like I can do this on the train or when I come home after an exhausting day at work. I fit this on a regular piece of blank paper - landscape orientation, .24" margins. I'm technologically backward otherwise I would post the file!

Often times, it was easy to do what I was told. But my professor was right when she said...but that's not what I went to school for. The treatment planning sheet helps guide you to progress a patient to meet their goals... which makes sense... doh, that's my job!

Picture from SILive.com and Simpsoncrazy.com.

Textbooks in Library

I hate buying textbooks.....$75 here, $45 there. Suddenly, I just spent $250 on textbooks. That's 250 slices of $1 pizza.

I considered renting or buying them used. Sharing a book with my classmate. Shhh even photocopying.... which I actually have never done. All in all, paying for textbooks is painful. However, I found the neatest thing - my program placed copies of the textbooks in the library.

The library is something I used to go to regularly back in the 1990s. Maybe in the early 2000s. But in the digital age, everything I need is on the internet. The library now is just a place to use their computer labs.

So before you shell out all those dollars to buy the textbook, check your school library. Also note, they might only have an older edition available. You might want to check how the editions changed before you go reading the entire 1st assignment.

I wish my library looks as gorgeous as the George Peabody Library.

No, it looks more like this...

Picture of dusty books from the Guardian.

Its my last academic semester....

...and I feel like throwing up.

At this point in my academic career, I have all the knowledge that I will need to practice. I was reviewing the brachial plexus with my classmate and I could barely remember which way to draw the lines. Yikes! I was reminded in class that "the masters do the basics well." What does it say about the amateurs?

I have a plan... to plan out the next 11 weeks and review my anatomy, kinesiology, modalities, diagnosis & management notes from musculoskeletal & neuro, etc. Shortly after my classes end in Nov, my program has a comprehensive exam that covers everything that I was taught. I barely passed my last comprehensive exam so needless to say, I am nervous. But I always believe that if you practice enough, you will get it [whatever it is]. Lucky for me, I have a classmate that is as keen to study as I am.

Fall is here & Pumpkin Spice Lattes are available at Starbucks. I'm sure that I will get through the semester with lots of caffeine.

Picture from Reinventing Mommy.

Have you gone to a Recruitment Fair?

I went to NYU's Recruitment Fair a while ago but too lazy to post until now. It was good practice for next year when I have to look for a job after graduation.

Top things I took away:
- Dress up. I think its always better to leave a lasting impression of looking good rather than looking like an amateur. Button down for men. Blouse for women. Slacks for both. Suit jacket, not necessary. 
- Come with a resume. Why wouldn't you, its a recruitment fair.
- Ask questions. Like all the sites & interview books say, its as much as an opportunity to interview them as it is for them to interview you. Also, its just a recruitment fair and the likelihood of them remembering you if you asked a "bad question" is slim. It will be good practice for when you have to ask questions for the actual interview.
- A lot of companies recruit from North Carolina, Virginia... down south because there are no PT schools down there. This is just an odd fact that I found interesting.


My favorite questions to ask:
1. What is the ratio of new grads (0-5 years out of PT school) versus older PTs (5+ years)?
    - You get a sense of the staff demographics -a seasoned support staff or all new like you.
2. What do you like about working at your institution?
    - You can tell if someone likes their job or company or not. Sometimes, they will give you dirt of what
       he/she hated in their last jobs. PTs are so honest. 
3. What are the biggest challenges for new grads? How does your institution help with the transition?
    - You can get a sense of the types of challenges that you may/may not have in this setting. 
4. Are you a PT? How long have you been at this company?
    - I always like it when companies send PTs to the fairs. Then you can actually ask questions   
      about the workday rather than get an automated response from an HR person that knows second hand
      about the institution that you are looking into.
5. Do you have any special programs geared toward new grads?
    - Some institutions - Visiting Nurse Service, Fox Rehabilitation offer a mentoring program & scholarship
      opportunities to new grads. I think its a selling point and would be more attracted to a place that offered
      it. Also find out how long it has been running and if there is a time commitment in order to be in the
      program.

I asked A LOT of questions to see what stuck. If someone finds your questions annoying, well.... they should not be representing their company at a career fair. I definitely made note of those places.

Picture from California State University.

Hola, me llamo Jennifer.

Nothing takes the place of having excellent verbal & physical cues. I believe the best physical therapists can apply the right kind of pressure on a patient to indicate what motion he/she would like the patient to do [ie. during a MMT] and minimal conversation has to take place. However, I suck.... ahemmmmm-am learning. I have a lot of Spanish-speaking residents/patients at the nursing home and I decided its best that I learn a few verbs & phrases to help me with the evaluations & treatment.

I made a cheat sheet [1-sheet, 3-column word document] with words pulled from Texas State University -San Marcos site and slipped it into my folder that I carry around. I hope this helps you as much as it helped me! Mavro also has an application for your iPad/iPhone.

Picture from iTunes.com.

Popliteal Pulse

Finding the Popliteal pulse is hard work. Patient or classmate is sitting in supine with the knee bent. I'm searching and searching their Popliteal space behind their knee. First I hear that its more medial and when I can't find it, I'm palpating laterally. Not getting the best feedback from my professors or assistant professors. A whole semester goes by and I still have not felt the Popliteal pulse. Its like searching for gold.


Then in my clinical decision making class, this professor watched my class as we felt around with a lost look on our faces and said to us.... its because you're not deep enough. You need to grab the knee from both sides and push [your beautiful trimmed] fingers [from both hands together] into the center of the space. Let's just say, don't be surprised when you find out this pulse is A LOT deeper than you think.

Picture from University of Glasgow.

Nursing Home Internship

I never got a chance to write about it but....I got into PT with geriatrics in mind as my end goal. My dad and stepmom are seniors and they were the ones who got me interest in physical therapy for the elderly. They both received therapy and talked very positively about the profession. Then I volunteered at a extended care facility that catered to the senior community and I was sold. I knew my clinical rotation at the subacute facility would either solidify thoughts or remind me that it is very different to observe a profession than to do the work in the profession. So far......


So good. I really love the company of people that are in their 60s-70s-80s-and 90s and 100's! Its crazy to be in the company of someone with so much history! Love talking about old NYC and Queens. How people from their generation used to fall in love, develop relationships with their family, the war, recreation and work. My supervising therapist said the best thing that I have to totally agree with. When working with the elderly - you are really helping them with life. Being able to maintain independence and dignity in your golden years is very difficult as your body begins to deteriorate. I really feel like I'm helping people when I get them to walk, stand up, sit down, manage stairs, move from bed <--> to chair/wheelchair with as little help as possible. Hope this feeling lasts.

Picture from thinkprogress.org. 

Second clinical internship

I started my second clinical internship at a nursing home/subacute rehab center. I will here for 9 weeks. On the first week, I almost broke down in tears. Saddest thing - I have the coolest and informative CI, a comfortable schedule from 8-4, a great supervisors that guides me with my treatment, and some pretty awesome coworkers and students alongside with me. But I was plagued with this fear everyday that I was supposed to know how to act in front of the nurses, doctors, other therapists, how to do a perfect exam, diagnosis, etc and that I should be able to treat 50% or more of a full time PT workload. Stupid APTA guidelines. I felt like I wasn't doing enough. I nearly passed out while listening to my CI because I was so overwhelmed by all the things that I thought I had to be doing perfect.


By the third week, I got the hang of things. I kinda ignored my weekly progress notes until the 3rd week because I couldn't bear with the thought of being told that I suck. But I bit the bullet this week and wrote about my 'concerns'. My CI's response on my weekly progress report....'student has high expectations for herself compared to most students which makes her feel overwhelmed. Just focus on basics, it will get easier as student get familiarized with all the forms.' FINE, I am drama queen. Maybe things aren't that bad. Her note made me feel better.

Picture from wired.com.

Do you know who Sheryl Sandberg is?

You have probably seen her a million times in the news...her speech at Barnard, her work at Google, and then her work at Facebook. Now her book. I know of her and was touched by her speech on "having it all." I didn't read up about all the backlash that came afterward and her lack of duty to feminism. I may or may not read her book.

This weekend, my best friend spoke about Sheryl Sandberg's talk at a CEO conference. My best friend said a ton of amazing things that I cannot re-articulate because I am not NEARLY as well spoken as the bf but the one thing that stuck with me was the idea that young women should not have to reach a point in their life and choose between having a successful career and having a great family. When the family happens, then.... you figure out how to mesh the professional life with the personal life. Sandberg mentioned that one of her younger colleagues at Facebook was asking for advice on how to start planning her professional life for her future family. This younger woman was just out of college and I think she didn't have a steady boyfriend at the time but she was already planning on this life event that hasn't even happened yet. Sandberg encourages young women to pursue the career, don't hold back (our male counterparts aren't), find a partner to support you on your path and worry about the family when the time comes. 

I confess that I have this imaginary child and family in the back of my mind when I think of where I want to work when I graduate. But after speaking with my girlfriend, I am reminded that its ok to go where the most exciting opportunity is (or whatever opportunity that I have access to! ha!). And when it comes time to start that family, it will be a joint conversation and effort with my partner.

Picture from Businessinsider.

Early Intervention Part II

So I'm a silly silly ass. I thought I could just jump into Early Intervention (EI) like post-grads work in a orthopedics clinic after PT school because they are interested in "Ortho". I'm in my 7th week of Pediatric Dx & Management and we finally got to the part about working in Early Intervention. My professor broke it to me lightly and kindly, that therapists usually work in a school setting with the 3-5 year olds or in a clinic for kids of all ages for a few years before they even go near the 0-3 year olds. Makes sense. She must have thought, "Jen must be out of her mind if she thought she could go near anyone's baby with next to no experience." Sigh, I must sound really naive to people when I tell them that I want to work in EI when I graduate. Eh, live and learn.

Cute baby pic from CDC website that list baby milestones. 

Also an incredible powerpoint with fantastic pictures from Missy Rose and Lois Bly describing normal and abnormal infant milestones from 0-12 mo. It was really helpful visual when learning about developmental milestones.

How to be less awkward in a conversation with 3 people?

I always get into those awkward 3-way conversations. There are three people standing around a group. And one person seems to only be talking to me and the third person is left out of the conversation. This makes me feel incredibly uncomfortable.

I picked up a neat fix to this problem. When someone starts to address and only talk to you, you just look at the person that is talking, then make eye contact with the third person (and maybe add a smile). The person talking usually notices and opens up the circle and begins to address both of you. Finally then, you get a proper 3-way conversation.

I was so thrilled to see Bain & Company Chairman, Orit Gadiesh mentioned this similar technique in her interview with Maire Claire. Different context but same idea.

How We Die

It was so nice to wind down with a damn good book. I read How We Die over my Xmas break. I found the title from a blog post named, "Have you ever fallen for someone's ...bookcase" from my favorite blog, Cup of Jo.

Its a beautifully written but insanely detailed account of how people die - heart disease, stroke, cancer, "old-age,", Alzheimer's, accidents, euthanasia...and more from the eyes of a doctor. He describes the disease in a both scientific but poetic way that you can visualize what's happening to the person. In class, I learn and memorize about different pathologies and treatments for patients. But it feels so foreign and distant. The book brings together all the knowledge that you have learned over the years in school, from the news, from your parents/grandparents, your friends and makes sense of it by putting the information in the context of individual stories.

My bro says I'm kinda morbid that I want to read a book about death over Xmas. I think the book demystifies death and I'm happy to have read it. And its a great adjunct to classes like pulmonary or cardiac PT.

Picture from Goodreads.

Peds: Early Intervention

I met this incredible woman at a APTA conference. I spoke to her for about 30 minutes over a terrible boxed lunch about her background. Out of PT school she planned on working on sport injuries but she got a scholarship through the NYC Board of Education and committed the first 2 years out of school to working in a NYC public school with kids. She had her last affiliation working with kids with neurological damage and has been working in Pedatric PT since. 

The incredible part was when she would describe her techniques. She has been known to be unconventional but effective. With a kid with CP, she would bandage his legs together to help him with crawling. I'm guessing that the legs of kids with CP are usually splayed when they are born. Some people would be appalled at the idea of tying any baby's legs together but with the permission of the kid's parents, she would do it. She says parents with kids with disabilities are more open to these ideas because they want to do everything in their power to help their kids live a normal life. I gathered in my studies that kids have to reach their developmental milestones -crawling, standing, walking by a certain month or risk being severely setback by their disabilities. 

In this case, she said the wrapping of the legs worked. She's seen the kid grow up and walking with some assistance from crutches. That was one of her cheerier stories. She discussed the downsides of working in early intervention of kids with disabilities but she seems energized by the success stories. In addition to helping babies, she finds the field extremely interesting. There isn't a ton of manuals on how to handle the various presentations of CP, down syndrome, autism, muscular dystrophy, etc. With this population, she gets to be really creative with her interventions. And she supplements her knowledge with continuing ed classes like the one I met her in, pediatric vestibular dysfunction. 

I never thought about working with kiddies but this really amazing woman turned me on to the idea. 

Picture from Torticollis Therapy Blog.