Hi All,
This week I had to review a patient’s short and medium term goals for a team meeting. I have been working with this lady, who is 2 months post right MCA stroke for 3 weeks now and have seen good gains in the muscle activation of her upper limb. So, one of my goals was to improve the fractionated movement of her upper limb to enable some use in ADLs over the next 4-6/52. Before the meeting, I had to discuss the goals with my supervisor. She told me that this goal was unrealistic and it was unlikely that the patient would ever have very good function of the limb. I was quite surprised and confused because the patient is already able to use the arm with minimal-moderate facilitation and has been improving. But with such little experience, I wasn’t confident enough to say this to the supervisor because I thought that maybe I was just being too optimistic. Later in the week, after I had the afternoon off and my supervisor had to treat this patient, she told me that she thought that the goal was realistic and that she hadn’t realised the current status of the upper limb because she hadn’t seen the patient since I had started treating her. From this experience, I have realised that I need to improve my confidence in explaining my assessments and thought processes. I may still be wrong, but at least I’ll know why I am wrong and be able to learn from the process, rather than just being confused.
Mel
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2 comments:
Hey Mel,
That's true to say that we as students need to have more confidence in ourselves while explaining the results.
I found this to be true at my neuro placement in the rehab ward where patients are improving week by week. One of my patients didn't have sensation or any voluntary control in her arms and my supervisor said that it's a waste of time to work on her arm than her leg. I thought may be this is true.
But the next day when I was trying to get the patient to do some active hip extension in sidelying, I gave her rest. In the meantime, I asked her to extend her elbow - looking into the mirror.
At first I thought may be Im wasting time - but she was moving active assisted looking into the mirror - which was giving her some sensory feedback.
I explained to my supervisor that this was so and she said to keep persevering with this. Even if it's a little bit.
So it's worth going ahead and having more confidence in urself and more importantly in your patients that they can do it.
Hey Mel,
I think it’s really important to explain your clinical reasoning to supervisors (even if it turns out you are wrong!!) If you don’t explain why you did what you did, or why you think what you think, then your supervisor can come to their own (possibly wrong) conclusion as to what you thought or did, and won’t really know where you are coming from. I think it’s really important to express our thoughts, especially now that we are almost at the end of the road, because in a few months we’re not going to be ‘students’ to our supervisors, but ‘colleages’. It’s quite funny where I am on prac at the moment there at 2 physios who went through the GEM program with us. It’s amazing to see how differently students are treated compared to the GEMs, even though we went through uni at the exact same time as them, and they only have a few months experience on us!! Their clinical reasoning doesn’t seem to be judged very often, whereas as a student we are constantly having to justify what we did and why. Anyway I think I have gotten a little bit off track, but I reckon explaining yourself to a supervisor is never a bad thing… if you don’t speak up they might think you’ve got no idea what you’re on about… and if you do speak up, you may be wrong, but at least they’ll see where your thought process is, and can direct you in the right direction. Ezza
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