Elizabeth Osantowski

PTH 634 Clinical Education II

Reflective Journals

Journal #1 Week 1: 05/13/2019 – 05/17/2019

I am completing my first rotation at Athletico Physical Therapy of Dundee. On the

first day, I woke up early and my day started by completing orientation with my CI. This

consisted of going over the requirements of Athletico, signing documents, and making

weekly goals. My CI and I got to know each other briefly and then our first patient

arrived at 8:30 am. For the first day, I mostly participated in shadowing and

observations of my CI with her patients. I was focused on meeting the patients, learning

the way they complete exercises, and the documentation process/format.

My second day of clinicals I shadowed under another PT in the clinic due to my

CI having required meetings all day, so she was out of the office. I spent the day still

learning the exercises, but I started to take initiative on helping take the patients through

their exercises by doing what I knew with them as it was a busy day. The PT thanked

me for the help, which made me feel like I was starting to be a part of the team.

The third day of clinicals was a crazy day. The clinic was busy and one of my

CI’s kids were sick, so she had to leave early to take care of her child. I was very

understanding of the situation as this sort of thing happens, especially with young

children. I worked the rest of the afternoon with the other PT again and I think it went

well. I got to see different cases, new faces, and new exercises. Additionally, I got to

take some ROM measurements and took the initiative to grab patients charts and walk

them through their exercises. I was able to demonstrate my knowledge of exercises and

show my communication skills with the patients. This day also consisted of two different

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patients’ coming in with possibility of infections at their incisional sites. The PT let me

ask the patients questions of symptoms they were experiencing, so I felt like I was able

to demonstrate my knowledge.

The fourth day of clinicals consisted of continuing to get oriented and had my

weekly meeting with my CI. At that time, we discussed things that we both thought were

going well and things that needed improvement. I told my CI I thought everything was

going great and I felt like I was learning a lot. My CI had given me feedback saying that I

needed to work on my ROM because the indicator segment wasn’t exactly the way she

wanted me to take measurements. I briefly explained to her what I was taught, and she

realized we were taught slightly different than she was. I thought this conversation was

handled professionally and respectfully, but now I am aware of what she is looking for.

Furthermore, my CI told me she thought I had good interprofessional skills and behavior

and she really liked how I take initiative with the patients when they walk in the door.

Together, we made goals for Week 2 of clinicals, which consisted of taking ROM’s,

MMT’s, STM, and learning the computer documentation process. My CI also added that

Week 2 is when I will complete my first SOAP note. Hearing this made me very excited

for the upcoming week.

Fifth day of clinicals consisted of shadowing the other PT in the clinic again.

Since my CI had the day off, the floater PT substituted in for her, which allowed me the

opportunity to see how other PT’s perform exercises, how they communicate with their

patients, and how they assess patient’s during treatment sessions. This day was very

exciting because I worked with two patients on my own. For one patient, it was her first

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treatment session, so I got her folder with the exercises my CI wanted her to complete

but it did not contain any parameters due to it being the first treatment session. I was

given the freedom to pick the parameters that I thought were appropriate for each

exercise, so I am looking forward to communicating with my CI to see her thoughts on

my choices.

Overall, this week consisted of a lot of observation hours. I anticipated that the

first week would be like this as my CI wants to see how much I know and become

familiarized with the clinic and its patients. I was very excited that by the end of the

week, I built up the initiative to be able to work with 5+ patient’s per day independently

with exercises. Other things I thought went well for the first week was being able to

complete some ROM measurements and a few modalities including hot pack,

ultrasound, and ice packs. I was rather bummed that I didn’t complete my first initial

evaluation yet, but I was able to watch all but one of the evaluations that we had for the

week.

One thing I struggled with was how to communicate with my CI when I had

questions. There were several moments were my CI didn’t tell me what the patient’s

diagnosis was or any history of them, so with one patient, I took initiative to ask the

patient in front of my CI what their diagnosis was. During our weekly meeting, she

requested to write down my questions and ask them privately after the patient was

gone. I did mention that I wanted to ask her which way she would prefer, so I was happy

we were on the same page. However, there are moments where I feel like my CI

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Reflective Journals

doesn’t have the time for questions, so I am not getting answers to them because there

isn’t any time to set aside for them at the end of the day.

This week I learned a lot, despite some moments where I felt I didn’t. I learned

the paper documentation process, majority of therapeutic exercises, and how the

equipment works at the clinic. I was able to demonstrate my knowledge when asked

questions and was even able to teach the other PT, Chas a special test (Torque test for

hip instability). Since the clinic has an OT (who also has a student from another

university), I was able to briefly observe how they make wrist splints and casts, which

was a great learning opportunity. I also thought it was beneficial to me that I got to see

both my CI and the other PT, Chas on how they perform initial evaluations. I was able to

learn other important questions to ask, how to respond to the patient’s questions, such

as “why do I need physical therapy?”, and how to transition throughout the examination

process. However, there were several moments that I felt like I was just a rehabilitation

technician again by only being able to complete exercises with a patient.

Moving into week 2 of clinicals as I stated above, my goals are to work on ROM,

MMT, STM, and computer documentation. I need to learn the different MMT scale that

they utilize which includes 4-. We were not taught this scale as we were told it is too

subjective, but my clinic uses it, so I need to learn it. Also, I hope to be able to

demonstrate my knowledge of STM and MFR techniques that I have learned throughout

last semester, so I can work towards having my own patients. My biggest goal is to work

towards completing an initial evaluation. I assume my first initial evaluation will consist

of direct supervision, so my next goal would to be indirectly supervised. Lastly, I was

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told from my CI that I will finally be getting my own laptop to be able to complete

documentation on the computer. This clinic utilizes both a paper and online

documentation process, and I have become familiar with the paper method, but was not

taught the online system yet.

My final thoughts on this week is that I have learned that I am ready for more.

Often, I found myself eager to do more as I haven’t been able to be hands on with a

patient yet, so there were times I felt like I was just a tech again. I understand that this

6-week clinical is different for everybody, but I am very ready to complete my first eval

and start progressing towards carrying my own patient load.

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PTH 634 Clinical Education II
Reflective Journals

Journal #2 Week 2: 05/20/2019 – 05/24/2019

Monday, 05/20/2019 consisted of shadowing the other PT in the clinic due to my

CI already having the day off for personal reasons. This day was productive as I got to

see more patients that are in the clinic with different diagnoses. I couldn’t do much

because the patients were mostly Medicare/Medicaid/Worker’s Comp and the PT

explained that I am not allowed to work with these patients. However, for the patients I

was able to work with, I took them through their exercises.

Tuesday, 05/21/2019 was an exciting day for me as my CI was back and ready

to get me going. I was able to take on 4 patients and independently take them through

their program. My CI only told me to do the one patient’s daily note so she could see my

documentation skills. I was told from my CI that she couldn’t get me another laptop, so

we were going to have to share hers. When she had free time, she would give me her

laptop, so I could do my documentation. Due to time constraints, she didn’t give me

feedback on this note the same day.

Wednesday, 05/22/2019 I received feedback from my CI that my documentation

skills were great, but I did not need to write out every single exercise with sets and reps

on the objective portion of the note as it was already in the treatment log. She gave me

a few more notes to complete on Wednesday, which I was able to prove my

documentation skills were great. She said she liked my notes and that I did a good job

on them. I was able to work with several patients on this day, but there wasn’t anything

different I experienced otherwise.

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PTH 634 Clinical Education II
Reflective Journals

Thursday, 05/23/2019, I was able to take goniometry measurements on the

shoulder and observed a discharge. My CI likes to test me on my measurements, so

she took measurements first without letting me see and then I performed them too. I

was also able to perform my first MMT in the clinic on this patient too (after she

performed them too). At lunch, we discussed our findings and she found I was very

close to her measurements, but our MMT scales were slightly different since I am not

used to using 4- and 4+, but ideally was the same. She also asked me why I had IR/ER

MMT flipped from what she had, and I explained to her that I wrote them backwards as I

get confused on those. My CI also taught me that she does a general screening of IR

and ER AROM by having the patient reach behind their back and assess what thoracic

segment level they are at as her measurement, but we performed PROM the same.

During lunch, I had my weekly meeting with my CI. We discussed that I was

improving with ROM of the knee, but I explained to my CI that I was having difficulty

with this because of inflicting pain to the patient. I told her how I feel super rushed and

with the patient screaming or crying and their leg shaking, I am just not confident in my

placements, especially being underneath her while she’s providing overpressure. She

explained to me that this would get better over time when I realize that inflicting some

pain to the patient makes them better. She said that my documentation skills have been

very good and said my communication and initiative with taking patients has been good.

I used this time to show my CI the syllabus for the requirements of this clinical

education experience, where she saw I needed to complete several initial evaluations

by midterms. She looked at the schedule for next week, where she saw she had no

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PTH 634 Clinical Education II
Reflective Journals

evals yet, so she gave me her Friday morning eval. I also made new goals for the

upcoming week, which included evals (if they are scheduled), more hands-on work with

the patients, and continuing to do notes on the computer. This day also included me

working with 5 patients and completing their daily notes throughout the day.

Friday, 05/24/2019 was a very busy day for me. I was given 50% of my CI’s

caseload for the day and needed to complete 2 daily notes, 1 progress note, and 1

initial evaluation. The day started with the progress note first, which was intended to be

an easier patient for me to do this with as I’ve worked with them before. However, the

patient had some issues resurface over the week, which made it a much more difficult

case to document. My CI overheard me talking with the patient about what was going

on, and she chimed in to probe questions and came to the same conclusion I did, which

is that the patient needed to be seen by his doctor asap. Then, I had a daily note I

needed to complete with the next patient, which went smoothly.

Then, the time has come where I completed my first initial evaluation with direct

supervision from my CI. The patient’s case was rather difficult for me to conclude a PT

diagnosis as everything I did (MMT, ROM, Special Tests, etc.) all came back WNL. It

was difficult for me to figure out what was going on with the patient exactly, but after

explaining to the patient what I found via their problem’s list, my CI chimed in saying she

agreed with everything. This made me feel significantly better about not having a

definitive diagnosis of the patient. Then, my CI let me create my own HEP for the

patient, taught them the exercises and stretches, and performed soft tissue work on

them. After I performed STM, my CI did too to make sure I wasn’t missing anything.

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Reflective Journals

However, she never came to me to tell me anything else was different from what I

found, so I think we are on the same page unless she is waiting until next week. Overall,

my CI said I did a good job on the eval, but I personally feel like I could have done

better. I felt like I should have done a few more special tests, a MLT, and assess the

patient’s balance, but time got in the way.

My day concluded with one last daily note with a patient I have worked with

before. My CI let me do hamstring stretching and passive ROM on this patient before

she came to take official measurements of his knee. It was very exciting to feel the

patient resist me during knee extension, but when he finally relaxed and I felt the end

range, it was very cool! Today was my first day experiencing any sort of pathological

tissue, so this second patient I felt it on was exciting and a great experience.

Overall, I completed the two daily notes and progress note before it was time to

leave as my CI and I have to share a laptop. I was unable to get to the initial evaluation

documentation, but my CI was not concerned about it and said she would teach me it

over the course of next week. Today was a very exciting day as it was my first day, I

was able to perform hands on work including STM, PROM, and MFR on two patients

independently.

My final thoughts for the week are that I need to be more confident with my

measurements and MMT. Although I struggle and can get confused with certain MMT, I

need to be careful during documentation on the movements I am performing during

MMT and check them. I also find myself second guessing progressing patients during

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Reflective Journals

exercises as I don’t want to step on my CI’s toes, so I often ask her before doing

anything with the patient. I also need to keep working on being more comfortable with

inflicting pain on patients during PROM since I hesitate and won’t push them to their

limits. This has improved with the more experience I am getting with patients, but I still

want to improve. I also want to improve my sequencing of the patient during an initial

evaluation. I had the patient in too many positions, but I did not want to forget to

complete certain things as I did anyway due to time. Overall, I felt like the week went

well. I see the areas I want to improve in and made my goals for week 3 where I plan to

(hopefully) achieve those.

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

Journal #3 Week 3: 05/27/2019 – 05/31/2019

This week I accomplished a lot. Starting off on Tuesday, I was given 3 daily notes

and 1 HEP to do. This day was very exciting for me as I was able to take my first patient

from start to finish, including their manual work, independently. Then Wednesday, I was

given 4 daily notes to complete. I thought I was completing the notes well, as my CI had

given verbal feedback that I was. Thursday came and I was given so much to complete.

I had two daily notes, 1 discharge which turned into a progress note by lunch. After

lunch, I completed 2 discharges and 1 daily note. Although this was very busy for me as

it was the most I have done so far, I was given the opportunity to practice my skills and

documentation. I also had my weekly meeting with my CI on Thursday where we

discussed things that were going well. My CI had utilized this time to show me more

things on documentation that she wanted me to complete, such as patient goals and

measurements, and, also started letting me sign my name on the notes. Friday is our

shortest day working, so I was only given 3 daily notes and 1 discharge to complete.

However, I was still treating more patients than my CI. On Thursday and Friday, I had

more patients and notes than my CI, meaning I had more than 50% of her load for those

days.

This week I learned a lot about documentation and patient education. Since I

performed numerous discharges, I was able to educate the patient’s on the importance

of continuing with their HEP, answering questions they had, and was able to design my

own HEP for them. Since I don’t have my own access to Medbridge, their program for

HEP, I had to always use my CI’s or the other PT’s. Therefore, it shows up as someone

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else’s name, but I am the one making them. I also improved upon my ROM

measurements. My CI always doubled checked my measurements to ensure I was

getting accurate measurements. My CI gave me verbal feedback on all my notes, which

she seems rather impressed with.

This week, I was able to get a lot of hands on experience. I was able to do STM,

get more experience with ROM and MMT, and complete more documentation this week,

meeting all my goals for week 3. The only goal I did not meet was completing another

initial evaluation. However, I think my CI is letting me get more practice with my

examination sequencing by letting me perform all the discharges for this week. My CI

provided feedback that my ROM was improving, and my documentation skills were

great, and my subjective taking is very thorough. She had no negative feedback for me

or anything I needed to work on.

My week 4 goals include doing another initial evaluation, keep performing

manual therapy on patients, and improving upon my sequencing during an examination.

My CI also added her own goals for me regarding documentation things she wanted me

to be able to complete, including signing off on notes and adding goals/marking them as

met or achieved if necessary. I found it harder to make weekly goals for week 4 as I feel

like I am doing ok on everything. My CI has given me a lot of free reign by giving me my

own patient list, allowing me to perform manual, take them through their program, and

write their note. Overall, I feel like this week went very well. My biggest goal I want to

keep working towards is completing another initial evaluation.

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

Journal #4 Week 4: 06/03/2019 – 06/07/2019

I found this week to be very relaxing and laid back at my clinical site. Due to all

the discharges I did the week 3, we had a decreased patient load this week and had

very few initial evaluations. My CI had continued to give me 50% or more of her patient

load for each day and I was expected to complete all of their notes as well, in which I

did in a timely manner every day. My CI performed the few initial evaluations this week

and explained that when it was a certain type of insurance or a direct referral from a

doctor, she needed to do those initial evaluations.

However, I was able to complete 1 initial evaluation this week on a patient with

bilateral patellofemoral syndrome. My CI and I both agreed that my examination

sequencing and flow of patient positioning went much smoother this time around. It was

challenging for me to come up with my own exercise program for this patient as I was

getting used to what my CI and other PT do for exercises and found myself wanting to

stray away and do some different exercises. I used my knowledge from being a PT tech

to elicit some different ideas for exercises and my CI and I went over the program to

discuss everything. She liked my program but pointed out that I need to continue to

work on placing each exercise strategically into the 4 categories: therapeutic exercise,

neuromuscular re-education, functional activities, and manual therapy.

My CI had taken the time on Friday, 06/07/2019, to explain to me that they use

the “core 4” to design all of their programs as it is required by Medicare. She further

went to explain that she believes one day, all of the insurance companies will follow in

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PTH 634 Clinical Education II
Reflective Journals

Medicare’s footsteps and want to do this, so she is already ahead of the game by doing

it this way in their clinic. She put me to the challenge to design my patient’s treatment

program and place each exercise into the 4 categories. Later on, we discussed why I

put things into each category and what my goal was for picking that exercise, and

although not wrong, she specifically said how she likes to place things and explained

her point of view.

Overall, I think this week went very well. I really like my clinic with both the

employees and patients. I am feeling really comfortable with everyone and am happy to

see the progress I have made since beginning the clinical experience. This week I

learned about billing and coding, how to write diagnosis and prognosis into the notes,

and was able to learn how to schedule patients. I was able to continue to get more

hands-on experience as I performed manual therapy on patients with low back, hip,

knees, ankles, and shoulder pathologies this week. I was given the opportunity to work

with patients I haven’t worked with before, but still have been unable to get exposed to a

lot of UE patients since majority are seen by the OT.

Also, I learned about the overhead throwing analysis program my clinic has.

Specifically, I was able to see old videos from patients they evaluated to be able to learn

how to take measurements on the program and know what things you want to look for

specifically like stride length, shoulder ER, knee flexion, hand positioning when

releasing the ball, etc. My CI explained that it takes hours to do an evaluation on a

patient with the program as you have to look at every detail and angle at each frame to

be able to give proper feedback to the patient. She went into detail about the pricing and

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process that an individual may partake in such as becoming a patient or doing their own

HEP. This program is very cool and something that sets my clinic apart from others as

this isn’t offered at every clinic. My CI played softball in college and has always enjoyed

overhead sports, so this is a program she is very excited to work with.

My week 4 goals consisted of performing another initial evaluation, continuing to

gain experience by performing manual therapy on patients, and improving upon my

sequencing during an examination. I completed all of these goals as I was able to

complete 1 initial evaluation, where I was able to demonstrate the improvements on my

examination sequencing. I was given patients all week long where I was able to

complete manual therapy on them. My CI also added her own goals for me regarding

documentation things she wanted me to be able to complete, including signing off on

notes and adding goals/marking them as met or achieved if necessary, which I was also

able to complete this week.

Moving forward to week 5, I found it extremely difficult to make specific goals of

what I want to improve upon except gaining more experience. I am finding it harder to

make goals as my main goal is to continue to get as much experience as I can, so I

often overlook the little details of things I need/want to learn before this experience is

over. I feel comfortable with my skills, but still get nervous over performing an initial

examination since my CI sits directly in on them. The three goals I did make was to

continue to show improvements with my documentation skills by completing parts like

billing that my CI taught me this week, continue to work on making POC’s and

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Reflective Journals

organizing exercises into the appropriate categories, and perform more initial

evaluations.

My CI did tell me for the upcoming week, the clinic has 12 initial evaluations to

do, and my CI had 6 of them. Due to certain insurances and direct referrals, I will only

be able to perform 2 of her 6 initial evaluations. The first patient I will be seeing on

Wednesday is coming in for a hamstring strain and the second patient I will be

examining on Friday is coming post-op TKA who is a son-in-law of a current patient of

ours. My CI said she is looking forward to seeing how I do with performing a post-op

initial examination as I haven’t done one yet, and with the additional pressure of being

referred from a current patient of ours. Also for week 5, my CI and I have my meeting

with Linda Hall on Tuesday, 06/11/2019, which I am looking forward too.

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PTH 634 Clinical Education II
Reflective Journals

Journal #5 Week 5: 06/10/2019 – 06/14/2019

Starting this week on Monday, 06/10/2019, I completed 4 daily notes and 1

discharge. My first patient that I completed an initial evaluation on and have been

seeing independently showed up to her appointment with interesting information, which

raised questions. Two weeks ago, my patient reported to me that her opposite leg that

she was being seen for locked into full extension during walking. She said it lasted a few

seconds and then she was able to control her leg again. I documented this episode at

that time, but then she came in Monday and reported that she was experiencing a lot of

bilateral lower extremity cramping over the weekend, which followed no peripheral or

dermatomal pattern. My patient kept saying she believes she was low in magnesium

and that is the cause of her leg cramping. However, the episode of the locking of her

legs made me think of spasticity. My patient has a history of MS but was told in 2015

she was in remission and no longer required medication, so she hasn’t followed up with

her neurologist in 4 years.

Luckily, I already took pathophysiology 3 and was aware of the signs and types

of MS to be able to recognize this as probably not muscular related. Since this was the

second episode of this, I went to my CI and asked for her opinion of it being MS related.

She said she didn’t know as she isn’t a neuro specialist and told me to research it.

Instead of researching it, I thought I could use better resources, so I emailed and ended

up having a phone call with Dr. Haines about my patient. I told her the history of the

patient’s MS and she told me what tests to perform to assess tone and clonus the next

time I saw the patient. I took this information back to my CI and asked for her help.

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On Wednesday, the patient returned, and we performed the tests, but they came

back negative. My patient was doing significantly well with her therapy and progress for

what she originally came in for, so we couldn’t justify keeping her for more visits.

Therefore, I ended up discharging her. I followed Dr. Haines advise to be very thorough

in my note and to explain the importance to the patient that she needs to go see her

neurologist for a follow up to make sure this isn’t MS related. I wanted to make sure I

put every single detail into this note, as I don’t want this to be missed when it gets sent

back to the primary care doctor in case the patient doesn’t follow up with her

neurologist.

This was quite the learning experience for me, but my CI seemed rather

impressed than I caught this. I wasn’t comfortable explaining to the patient that this

could be MS related as I didn’t want to say anything in the wrong way, so my CI did the

hardest part and expressed our concern about it to the patient. She immediately was

concerned and said she would follow up with her neurologist that same day.

Unfortunately, I don’t know what ended up happening with this patient, but I found this

to be a great learning experience. Even though I am in an outpatient setting, I still need

to be well rounded with my education in order to be able to recognize these signs for the

best interest of my patient.

On Tuesday, I experienced my first emergency situation in the clinic. The PTA

was working with a patient who had suddenly passed out on her. She called for the

other PT to help and he went running. When I realized what was happening, I yelled for

my CI who was a couple feet away at the front but couldn’t see the situation due to the

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wall blocking it. She realized something was wrong by the tone in my voice and also

seeing the other PT running, so she took off running to help the PTA as well. Suddenly,

it hit me that every PT and PTA was attending to the one patient, but there were 5 more

patient’s on the floor who needed to be helped. The tech was unable to come to work

that due to personal reasons, so it was only me that could help.

Without hesitation or asking, I went and gathered every single patient’s charts

and managed to take them all through their exercises. It was hectic as I had two

patients who were doing new exercises, which required teaching them the new

exercises, but I managed it. The PT’s and PTA were assisting the patient, taking vitals,

getting her food and cold wash clothes, water, etc. After the patient was stable, she

went home to the care of her grandparents who seemed like this was normal for her.

Apparently, the patient has a history of a few fainting spells. It appeared that she fainted

due to lack of food before therapy, but we don’t know for sure. After the situation was

dissipated, my CI came up to me and we discussed how to manage situations like that

and how important it is to remain calm, which I didn’t show right away as I yelled her

name, but I did after that. Every patient saw the situation that was happening and saw I

was the only one to help them, so everyone was very patient and kind with me. I did the

best I could, but this was a learning experience for me. I learned that I need to remain

calm immediately to emergency situations, but otherwise I handled the situation in the

correct manner by doing what needed to be done in the clinic. Everyone was grateful

that I took on their patients and got them through their programs for them.

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PTH 634 Clinical Education II
Reflective Journals

This week was a hectic week at the clinic, which was different than the week

before. Besides a patient fainting and discovering my patients MS could possibly be

back, we had a total of 25 initial evaluations in the clinic to complete between 2 physical

therapists. My CI had a little over 50% of the evals, but unfortunately, I was only able to

complete 1 of them due to the type of insurances the patients had. Most patients had

Medicare, which would require direct supervision for me, but the way the schedule is set

up, it wasn’t doable. I would continue working with the patient before the evals, and after

they left, I would jump in on the last 30 minutes of the eval. This made this week rather

slow for me, as I only had daily notes to complete. However, I was able to complete 1

initial evaluation, but I was originally supposed to have 2.

My first eval was a hamstring strain, which I researched and prepared for, but

then found out I couldn’t perform that eval due to his insurance type. Instead, I got to do

an initial evaluation on R shoulder rotator cuff tendonitis. This eval was rather

challenging for me as the patient only would give one-word responses to any questions

I had. This made getting subjective information out of the patient very difficult, but I did

the best I could. The examination, assessment, and POC parts of the eval went

smoothly. My CI gave immediate feedback after the patient left and said she agreed

with all of my measurements and examination and overall did good.

My second eval was supposed to end the week on Friday, 06/14/2019. The

patient was a R TKA revision, meaning he had a TKA before and got another one. The

patient called first thing in the morning to tell us that his incision has not stopped

bleeding and his knee was “ballooning” up. He said he was contacting his doctor’s

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PTH 634 Clinical Education II
Reflective Journals

office, but they didn’t return his calls, so he went to the ER where they bandaged him

and sent him home. The patient was very angry with his doctor’s office and the ER and

was seeking advice of what to do. My CI took the phone call and told him she would like

to see what the knee is looking like to know if it was normal edema or blood pooling that

was occurring. She explained that since his surgery was Tuesday, that she wanted to

get him in so he would start moving as soon as possible but advised him to call the

doctor’s office again and see what they say. A couple hours later (and a few minutes

before he was supposed to arrive), he called back to say that his doctor wanted to see

him immediately and he wasn’t going to make it to therapy. He was going to reschedule

his appointment once he knew what was going on with the doctor. I may be able to

complete his eval next week, but it will depend on the scheduling.

Overall, this week went smoothly. I was able to perform 50% of the CI’s caseload

every day, I was able to complete discharges on a few patients this week, and I was

able to perform another initial evaluation. I was happy I was able to get exposed to a

patient with a shoulder pathology as most patients with any UE pathology is typically

seen by OT in this clinic. Typically, I work with patient’s who have LE pathologies.

During our weekly meeting, my CI gave me feedback which consisted of saying I was

doing really well, and she had no complaints for me. She said for the final week, she

was going to make sure I was able to perform billing and do some unique tests that they

have in their clinic including a y-balance test. Forming goals for the final upcoming week

was very difficult, as I just want to continue to gain experience and perform another

initial eval. Otherwise, I don’t have anything specifically I want to try to accomplish. It

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

was also brought to my attention that my clinical site was hosting a going away party

next week, so I am looking forward to that. I plan to give everyone a ‘thank you’ card

with a personal note to everyone in the clinic as they have been very wonderful and

welcoming to me.

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

Journal #6 Week 6: 06/17/2019 – 06/21/2019

Beginning the week off on Monday, it was typical busy day. I held over 80% of

my CI’s caseload and performed all the notes in a timely manner. She seemed to be

very happy about that since she doesn’t like doing paperwork. On Tuesday, my CI and I

sat down, and she taught me the billing process, which was simpler than I thought it

would be. We did a few example problems and then proceeded to different patient’s

billing together and talked through it all. I thought this was very awesome of my CI to do

because she was able to answer all of my questions and make sure I fully understood

the billing process.

On Wednesday, my clinical site had their quarterly meeting, which I was able to

sit in on their meeting, but everyone called it “Liz’s going away party.” We all brought

Mexican food and we got to sit and visit with each other while enjoying good food. Then,

we proceeded with the meeting where they opened the meeting with thanking me for

being a big help to them and expressed that they would miss me when I leave, which I

thought was really sweet of them. During the meeting, I got to learn a lot more of behind

the scenes stuff like insurances and scheduling, which was useful information for me to

learn about. We returned to treating patients and this day was an important day

because I was able to perform a y-balance test on a patient of ours, which was a great

learning opportunity for me.

Since Friday’s are our shorter days and we don’t have lunch break, my CI and I

went over the CPI and all of our documentation, including Athletico’s and CMU’s, on

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

Thursday. My CI said she thought I was doing really well with the clinical experience

and had nothing bad to say, which is why she graded me so high on some of the

categories. Her recommendations were to continue to get practice with ROM and MMT

but verbalized to me that she thinks this will come with practice and repetition as I have

shown a lot of improvements in those over the 6 weeks. My CI also said they will all

miss me in the clinic as I have been a big help for them!

One exciting moment on this Thursday was that I was able to use a technique

taught in Patient Care 2 to help a patient. This patient presented with chronic low back

pain and piriformis syndrome, but explained he was having a lot of difficulty laying prone

and then moving his legs into hip extension. As I was doing manual work on him, I

thought about the sacrum and how it could be nutated since his lumbar had a lot of

lordosis when lying prone and thought why not do a joint mob to the sacrum? So, I did

just that and the patient thought it was magic since he had instant relief and was able to

move his legs with ease. He was so impressed with my joint mobilization as he

continuously thanked me and explained that he has saw “5 highly educated people and

none of them could do anything to help my pain.” It was a really remarkable moment as

I was really taken back by the quickness outcome of it. My CI seemed rather impressed

but did not make any comments regarding my joint mobilization. Since the patient

sleeps in a prone position, I further educated the patient that he should try sleeping with

a pillow under his belly and see if that helps alleviate his symptoms.

Heading into Friday, I had a small present for my CI to thank her for all the help

she has given me over the last 6 weeks. She has been going through a lot in her

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

personal life in which she shared with me over the course of the last 6 weeks, so taking

on a student wasn’t exactly ideal timing, but I am so grateful that she did. She was a

great CI, taught me so much, and helped me grow a tremendous amount over the 6

weeks, so I thought it was important for me to personally thank her. Throughout my

internship, she had a habit of stealing my personal pens I used every day, so I thought it

would be nice to get her a set of them. I also got her a coffee mug as she keeps one at

work since they have a coffee machine and just placed the pens in there. I also wrote

her a thank you card to give, but I also thought it was important to write personal letters

to every single person in the clinic to give to on my last day to thank them for being so

kind, welcoming, and helpful to me. All of these were given out on my last day, which

led to a lot of sad goodbyes to everyone.

Overall, I think this week went great. My CI and I made sure we got to finish all of

our goals this week which included billing, y-balance test, and exposing to me to as

many different types of patients as possible. I was able to sit in on an injury screen,

which was the first one they had since I have been there. My CI let me work with

several new patients, form my own POC’s placing each exercise into the core 4

diversification, and given me independence with patients. Throughout this week, I made

sure to say goodbye to all the patients I have worked with and made sure to take the

steps to transfer them into my CI’s care. I explained to the patient’s that I was returning

to class and they would move into my CI’s care and asked if they had any problems with

that. Every patient was very supportive of me going back to school and congratulated

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 Elizabeth Osantowski
PTH 634 Clinical Education II
Reflective Journals

me on finishing my first clinical internship and was more than willing to participate in that

POC.

I think this clinical internship has been a wonderful experience for me. I have

been able to see my growth from beginning to now, and I don’t think I would have gotten

that same growth if I was in a classroom. It is a whole different ballpark to be with real

patients who have real pain, but it was the best way for me to learn. Every patient was

more than willing to let me learn from them and gain experience with them. Since my CI

was from University of Toledo and the other PT was from Andrews University, they

taught me a tremendous amount and showed me a completely different view than what

we were taught so far. This also gave me a great opportunity to network with other

schools and build interpersonal relationships. I think I have specifically grown a lot in my

examination skills and techniques and have improved my critical thinking, problem

solving, and professional development the most. I think I learned and grew in every

category, but I still think I have a lot more room to grow, but it will come as I get more

experience. I think this clinical experience has boosted my confidence moving forward

in the program, so I will want to treat in Hands for Health and feel a lot more comfortable

starting to work with a HEP patient. This also gave me an opportunity to remember why

I am choosing PT and exactly what it means to me.

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