By the time we arrive at PT school we are arguably professional students. We have been in school longer than most and we have the system down. We take notes, we ask questions, we study and we are typically guaranteed good results. But PT school requires an extra step: the clinical affiliation. To us professional students, the prospect of a clinical affiliation can be both terrifying and exciting. We finally get to be out of the classroom and practice what we love, but we are also leaving our comfort zone of academia.

While it is true that you are more prepared than you think for your first clinical affiliation, I have found that it is helpful to be armed with concrete strategies when entering the unknown. Before my first affiliation in outpatient orthopedics, I was overwhelmed with the breadth of knowledge and skills I was expected to bring with me. In an effort to assuage my fears, I devised a plan that I thought would best help me succeed. The strategies I include in this guide are the ones that worked for me during my clinical affiliations in outpatient orthopedics. They helped me remain calm, they increased my confidence with the patients and they allowed me to maximize my learning potential.

Strategy #1: You are there to learn, it is OK if you don’t know the answer

One of my biggest fears upon starting my first clinical affiliation was not knowing how to answer questions asked of me by my CI. I was used to a school setting where I could prepare for the day, but a clinical affiliation was different. I would have to draw on knowledge from two semesters ago – and who can remember back that far?? It was when I finally accepted that I wasn’t supposed to know all of the answers that I was able to relax and learn.

So what is the best way to deal with a question you don’t know how to answer? From my experience, honesty is the best policy. Tell your CI that you remember learning about the topic in school, but that you can’t remember all of the details right now. Then make sure to look up the answer and share it with your CI later. They will be impressed with your initiative and you will be more likely to remember the piece of information in the future.

It takes confidence to admit you don’t know something, but you will be better off for it. If you don’t ask questions and get answers now, it will be harder to work this out in the future.  And remember, if you knew all the answers, you wouldn’t be a student. Your CI knows that.

Strategy #2: Make a cheat sheet for your initial evaluations  

Initial evaluations can be intimidating. When I first started leading initial evaluations as a student, I would often fail to collect all of the necessary information. My mind would go blank and I would have difficulty zoning in on the salient points. More often than not, I would lose my rhythm and my CI would have to jump in to rescue me. Needless to say, this was frustrating.

My solution: “eval cheat sheets”. I started prepping for evaluations with a basic outline of what I wanted to accomplish. The outlines may vary slightly from patient to patient, but having this piece of paper in front of me left me more focused and organized. I didn’t always rigidly follow the cheat sheet, but when I felt myself losing focus it brought me back on track. I could simply glance down and see what I hadn’t asked or examined yet. My eval cheat sheets were immensely helpful to my performance during initial evaluations. The process was more fluid, the patients seemed more comfortable and I didn’t require nearly as much assistance from my CI.

Here is an example of one of my eval cheat sheets. I have the history on one page and the exam on the other. Of course not every evaluation will be the same, but this is a helpful way to guide the course of any initial evaluation.

Strategy #3: Plan your treatments and you will appear more competent

In outpatient orthopedics you will find that there are many components to a treatment program. You have to split your time between manual treatments and therapeutic exercise. You also want to ensure that your interventions are appropriate for each patient’s level of function. As a student, I found that I was unable to effectively manage all of this without preparing. I realize that it may feel like a burden to take time each night to prep for your patients, but it will improve your performance as a student and as a new grad. Establishing this habit now will ensure that you are a more effective clinician in the long term.

At the end of each day, I would ask my CI to provide me with a list of the patients I would be responsible for the following day. That evening I would write out a few manual interventions and exercises that were appropriate for each patient and I would attach the plans to my clipboard. When I began to do this, I noticed that my patients started to trust me more. There were no awkward pauses in treatment and I was able to confidently relay my plans to both my CI and my patients. After a few weeks of preparing in this way, I found that I seldom needed to reference my clipboard during treatments. The simple act of preparing the night before was enough to help me remember what I wanted to accomplish the next day. Preparation is key as both a student and a clinician in outpatient orthopedics. 30 minutes each evening will save you 8 hours of stress the next day in the clinic.

Strategy #4: Educate your patient with pictures

It is never too early to learn that patient education is paramount to a patient’s success. On my first clinical affiliation in outpatient orthopedics, my CI encouraged me to use anatomy pictures or models to educate my patients. This is a strategy I continue to utilize as a clinician today.

At the conclusion of every initial evaluation, take the time to explain to your patient what you found and why you think it is causing them pain. As a student you may not feel that you are able to provide a diagnosis on the spot, but there are most likely findings from your exam that you can share with the patient. Remember, you know more than your patients do! Instead of simply telling the patient that he or she has a tight IT band, show them what the IT band looks like, where it originates and where it attaches. Your patients will appreciate your willingness to provide a frame of reference and they will be more likely to trust you with their care.

Strategy #5: Remember that we have all been there before  

It is the rare student who enters a clinical affiliation without being nervous. It is normal to feel this way! Your CI was once a student, your professors were once students and your peers are in the same boat as you are. You are not alone in this process and there are many people who are invested in your growth as a clinician. We are all in this together.

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