I graduate next month. It feels surreal. I’ve learned so many lessons over the last three years, especially during my clinical rotations.
Going out on internships during PT school is exciting, because it’s time to get into the clinic and — you know — do therapist things. No more Scantrons, very few Powerpoints, but just as many challenging moments. It’s a really interesting metamorphosis from “student” to “clinician,” even though every impressive clinician whom I’ve shadowed has maintained a student-like curiosity that blurs the line between these roles. Before internships, I didn’t anticipate some of the challenges of transitioning from class to clinic.
These are the three most important things that I wish I could go back and tell myself.
1. You don’t know much.
I showed up to my first internship feeling confident — way too confident. I knew that I had done well in class. I was far from perfect, but I was passionate about evidence-based practice and orthopaedics. Since I was heading into a clinic that had a reputation for evidence-based practice in orthopaedics, I was amped. I quickly realized that the role of entry-level education isn’t to prepare us for everything — that’s just impossible. Instead, our education should prepare us to avoid harming the public and to expose us to a big chunk of common conditions. We’ll see a lot of horses, if not that many zebras.
I noticed, though, that my profound lack of knowledge was more serious than a stale animal metaphor. I found that my eagerness to “do therapist things” needed a reality check. This tweet from Justin Scola illustrates my point:
— Justin Scola (@justinscolaSPT) March 25, 2017
I think I passed “Mount Stupid” during my first internship. I would go back and tell myself to be prepared to be wrong. I would encourage my previous self to ask for other opinions from more experienced clinicians who have already passed Mount Stupid.
I would also caution against beating myself up for being inexperienced. Even though I didn’t feel like an imposter during didactic coursework, I definitely felt it during internships. It’s a scary place to be. Cruz Romero wrote a terrific article about imposter syndrome, and I especially love his advice to adopt a growth mindset and consider moments of inadequacy as signs of growth.
2. Find ways to learn more.
It’s tough to feel like you don’t know much, so the next thing I would say is…try to know much more. Here’s where students can really shine, because we learn about new research in class, have journal access, and have the opportunity to provide in-services. Keeping up with research is difficult, though. Rich Severin wrote an awesome post about ways to stay on top of evidence, and internships are the right time to start healthy evidence-based habits. I used Feedly to keep up with my favorite blogs, and I used Podcast Addict to listen to physical therapy podcasts during my commutes. It was fun to hear PT podcasts that included a student perspective, like the Knowbodies (now new grads) and the Duck Legs Podcast. Twitter and Facebook are always teeming with PT discussions/debates/rants/tweetstorms. I went to AAOMPT and CSM conferences, and I would tell myself to try to go to even more conferences.
Learning is bigger than PubMed, though. I would have told myself to be a bit more adventurous instead of fearing criticism. My clinical instructor during my final internship once told me, “Don’t worry about making mistakes. That’s what I’m here for. I’ll let you know when I disagree.” That advice kind of blew my mind. I am typically pretty terrified of making mistakes, especially when it feels like our clinical instructors might “fail” us for making mistakes. In hindsight, I see now that my CI approached my internship with a growth mindset; he allowed me the chance to learn. I would tell myself to think about how all of my CIs expected me to make mistakes and to learn from them.
Unfortunately, you might not find yourself at an internship with a clinical instructor who wants to mentor you, who wants to help you through your mistakes, or who wants to learn from you. One of my classmates told me that his internship site — a “successful” outpatient clinic — refused to entertain in-services from students. My peer told me that his CI explained it this way: “Your in-service would either be about something that we already know or about something that we don’t care about.” SERIOUSLY? Hearing his story reminded me to be careful about acting like I know anything just because I’ve been reading journal articles. Clearly some CIs and clinics don’t value research literature or DPT education, yet ironically hoard CEUs for taking students without any semblance of a desire for continuing their education. More importantly, knowledge from research evidence is only one aspect of clinical education.
3. Get ready for feedback.
I would then tell myself that regardless of how much (or little) you know, and regardless of how much you learn, you will get tough feedback. I’ve heard stories from some classmates that they had CIs who gave very little feedback. Instead, those CIs kicked back and enjoyed free labor. I never had that type of CI. I had CIs who gave a lot of feedback. I always had formal, weekly discussions about my progress, and I received some type of feedback almost every day of internships. I’m actually thankful this feedback in hindsight, because I know that I’m better for it.
Even so, it’s an emotional challenge to be evaluated, especially if you’re passionate about physical therapy and want to be an awesome clinician. Gene Shirokobrod shared a helpful article in the DPT student Facebook group that I wish I had read before internships. The tips to pause, be grateful, and ask questions really improved my final internship.
Ultimately, I think I’m past Mount Stupid, but there’s still so much more to do and more to learn. I’ll keep this in mind as graduation approaches, and if you’re a fellow student, then I hope you will too.