The first value that I would like to discuss is accountability. For this clinical rotation, I was exposed to a completely different thought process / system for critical thinking than what I experienced in school. My CI has studied and obtained her FAAOMPT from Manual Therapy Institute, which takes a lot of it’s foundational information from Shirley Sahrmann. Under Dr. Sahrmann, there is a whole series of physical therapy diagnoses based on the patients presentation. Some examples of these diagnoses include extension rotation syndrome of the lumbar spine, flexion syndrome of the cervical spine, and supination syndrome of the foot/ankle. I had never heard of this physical therapist and was not aware of this classification system, so in the beginning of this internship, I found it difficult to understand the connections that Rachel made between presentation and symptomology.

In order to bridge the gap between what information I already had learned and that which Rachel had learned and utilized on a daily basis, I asked Rachel if I could borrow the Sahrmann textbooks that she owned and kept present in the clinic. Over the course of this internship, I did eventually purchase the second edition of the Sahrmann movement analysis book, and will be purchasing the third edition when it is reprinted/updated later this year or early next year. I found the descriptions of possible patient presentations, common compensatory patterns, and reasoning for why they were compensation in that way very helpful and intuitive, after a time.

In the future, I believe that I will continue to utilize these new sources of information as appropriate to assist me with identifying impairments and developing plans of care. I am glad that I took the time to utilize these textbooks while they were made available to me, and I feel that I can attribute a large portion of the improvement in my critical thinking skills to a seeking out this extra information, which facilitated my ability to better understand the mindset of my CI.

In addition, I was able to use this internship to become more comfortable communicating with other members of the healthcare team, including physicians, specialists, and other physical therapists. Not only did I use these opportunities to improve my professional communication skills, but it also was helpful for helping me pare down the information I do give in these conversations to only the most important. I am very lucky to have worked with physicians who highly value the input of physical therapists, and this experience developed my confidence with making direct recommendations about appropriate next steps for a patient.

For the second core value, I am choosing to discuss integrity. Obviously, this value can manifest in a variety of ways, from conscientiously working within the appropriate practice guidelines to having an understanding of the limits of your own abilities. In this particular setting, I was working intimately with the physicians next door on a daily basis. We were required to write small notes summarizing patient progress (or lack thereof) to give to the physician before any re-evaluation of a shared patient. In addition to the progress summary, we were also expected to leave a recommendation for what we believed should be the next step in the patients care. Depending on the situation, this could be a recommendation for imaging, for an injection/ change in medication, or a renewed PT prescription.

In hindsight, I think that this is a well thought out method of communicating between therapists and physicians who are operating under time constraints. As therapists, were are providers who may be spending the most amount of time working with patients, and because of that we may have a more complete awareness of changes to the patients’ presentation, their living/working situation, and conditions which may be hindering their progress. I know that over the past three months, there have been several occasions where a patient has a suspected rotator cuff tear, but had been sent to physical therapy prior to determine whether rehab would be enough to strengthen the remaining tissues and facilitate a return back to full duty. Often times, had they not recovered significant function over the first set of sessions, our recommendation for imaging to rule out a large tear would come back with confirmation of such a tear, and possibly a subsequent surgical repair. This is an example of times that I was able to identify that the patient was not recovering at the anticipated speed, and utilize objective measurements and familiarity with typical presentations to evaluate a case and recommend referral for further imaging.