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6 Ways to Prepare for the Transition from Student Life to Professional Life

If you're a physiotherapy student in Canada in your last year of your MScPT, you’re probably finishing up, or close to finishing up your last clinical placement. Congratulations! You’ve made it….almost! Before throwing in the towel because school’s out for summer, you may want to consider the following tips for a smooth transition into your professional physiotherapy life.


1. Apply for your provisional practice license now

If you’ve passed your PCE written component, you are eligible to now apply for a provisional practice license that allows you to work, and (and maybe even get paid) as a Physiotherapy Resident. If you want to get familiar with college application processes and standards of practice, now is a good time to start. You never know when a Physiotherapy Resident Position might open up, and you’re better off being registered and ready to go when it does. Which leads me to my next point


2. Work as a Physiotherapy Resident ASAP

If you get the opportunity to practice now, jump on it. Hopefully, many of you can roll out your last placement into a Physiotherapy Resident position. It can be tempting to take time off and just focus on studying for the clinical component of the PCE, but having a Physiotherapy Resident position is really the best way to practice your skills for the PCE and for life as an independently registered PT. As a PT resident, you are monitored and supervised by an experienced physiotherapist and will be given many opportunities to observe, participate, and review/reflect/and receive feedback patient care activities. It’s a fabulous resource to get you set up for independent practice. To avoid picking up bad habits however, you might want to consider my next point.


3. Practical Study


This is an important part of our profession, always. Outside of working as a Physiotherapy Resident, form study groups now and make a schedule to go through practice scenarios with your peers. For more tips on how to prepare for the clinical component of the PCE, see my blog post 5 easy tips to keep in mind before the upcoming clinical component of the Canadian Physiotherapy Competency Exam (PCE). You might also want to consider the PCE prep course hosted by pthealth. The prep course is a 4 hour mock exam that gives candidates a similar experience to the actual PCE. Candidates will be given feedback on strengths and weaknesses, and suggestions on how to improve for the the PCE. The prep course is hosted in several locations in Ontario, British Columbia, and in Calgary. For more information click here.

4. Choose continuing education courses wisely

It may be tempting to overload yourself with courses to equip yourself with skills for entering practice, but don’t forget about the skills you already have and need to solidify. Your existing assessment skills will probably be the most valuable tool to your clinical practice throughout your career (being new grads you are up to date on the most sensitive/specific special tests and research) so don’t disregard these skills.

If you are in orthopedic/MSK/private practice, now is this time to solidify the assessment skills you have in this area of practice before jumping onto learning yet another technique. In my experience, many of my peers went on to take acupuncture courses before even taking their PCE clinical exams or working. This meant that before really applying their existing manual skill set, they were already bringing on more information and material to retain. Remember, acupuncture is a rostered activity that requires additional training to perform (there will be no acupuncture questions on the PCE), so why stress yourself with additional information before the main qualifying event? Not only is it a ton more work, it’s also more time, more money, and more studying for now. You can always take acupuncture courses in the near future. Trust me, the scope and variety of continuing education courses is endless and are always being offered. When you are ready for more, check out Physio Course for listings.


If you are anxious to take a course now, however, I would recommend the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) Part A; Lumbar exam. If you are in MSK practice, this will make your clinical practice immediately and infinitely easier. You will see many low backs in your MSK career, and this course is short (weekend), reasonably priced, and so much more than just “extensions” that you have probably heard about in school and on placements. It will give you a great deal of confidence in how to assess and treat low backs, and most importantly, introduce you to the effective powers of patient education.

I would also recommend taking a course or two offered by the Advanced Physical Therapy Education Institute (APTEI). These courses are short (usually only one day), inexpensive, and you always leave with 3-5 instantly applicable and useful tips of clinical practice. Bahram Jam is also an approachable and energetic instructor who has an infectious personality that helps students get excited and enthusiastic about practice. You can check out some of his content on healthSwapp exercise library (sign up for free here) for a preview of his material.

Finally, if you are considering undergoing the Canadian Academy of Manipulative Physiotherapy (CAMPT) process as part of your manual therapy training, consider challenging the level one exam in the new year. It is inexpensive and requires studying the material and completing an exam by an invigilator of your choice (so no need to attend a course or exam site). If you find it useful to your career path and you successfully pass level one, you can apply to the subsequent levels to become a full FCAMPT therapist. Alternatively, if you love manual therapy, you could consider skipping the FCAMPT process altogether by going back to do a one year Master of Clinical Science in Manipulative Physiotherapy (MCISc) at the University of Western Ontario.

5. Practical Guidelines for Success in Private Practice

I had the good fortune of being able to work in Australia as a physiotherapist for several years at a clinic that did a wonderful job of educating their physiotherapists on how to garner success in private practice. Their emphasis on developing quality characteristics as a physiotherapist were probably no different from what we would promote that makes a great physiotherapist here in Canada (care, empathy, listening skills, good diagnostic and manual skills etc), except for one thing: the number one skill that often gets over-looked is the physiotherapists ability to manage client expectations and bridge the gap between client and therapist expectations.


So, as a physiotherapist, what are our expectations of our clients? Here are some suggestions:

 
  • The client wants to be there
  • On time for appointments
  • Clear and concise answers
  • Honest
  • Communicates regarding the treatment: during and after
  • Performs exercises
  • Follows advice
  • Has reasonable expectations of the therapist

And as a patient, what is the expectation of the physiotherapist? These include:

 
  • Professional in appearance and attitude
  • Care/empathy/listening
  • Explanations
  • Planning
  • Diagnosis
  • Confidentiality
  • Respect
  • A positive effect from treatment
  • Hands-on therapy
  • Improvement
  • Timeliness
  • Continuity of care
  • Consistency of care between clinicians
  • Booking availability
  • Booking correctly
  • Good magazines
  • Easy parking
  • Comfortable chairs
  • Safe equipment
  • Polite receptionists
  • Modern facilities
  • Able to get through on the phone
  • Online booking and information

Despite what we may think, many of these expectations are within our control based on how we communicate with our patients from the very start at the initial assessment. The patient’s intake form will give you some idea of what the patient expectations are, and it is a good idea to discuss and manage these expectations right away to reframe and counteract any problems that might begin right from the start. If the patient had a terrible experience with physiotherapy before, find out WHY and develop a strategy to avoid a similar experience.

Tips for the initial assessment:

  • Introduce yourself and the assessment process (especially if the patient has never been to physiotherapy before)
  • Ask for consent. I mean literally say “ do I have your consent to proceed with the assessment?” And document this.
  • Explain your findings, diagnosis and plan as clearly as possible using simple language. Use diagrams, online software, models etc. Educate and involve your patients. They will be impressed that you took the time to do this
  • Suggest a treatment plan and give a timeframe. Be realistic about the timeframe for healing. Explain how the treatment plan relates to the patient’s specific goals. Again, ask for consent and document this.
  • Use outcome measures from the start. Later on down the line if the patient says they feel they haven’t progressed, but outcome measures show they have improved, it can help with their perception/expectations of progress
  • Be clear about your expectations now. If you expect the client to do their exercises to see improvement in their condition, say that now. Give the patient a clear description of the frequency, intensity, time and type (FITT) of their exercises. healthSwapp has a growing library of patient exercises that practitioners can provide for free to their patients, and allows patients to observe their exercises in video format, as well as track their progress for their benefit and yours (you can see if/when/why treatment needs to be changed, progressed, or stopped with this information).
  • Educate your patients on what to expect after the assessment and with their HEP. They may feel sore after the assessment, so tell them this and explain why. Their exercises may give them delayed onset muscle soreness (DOMS) - explain this and that it is normal. Distinguish discomfort from pain with the HEP and give instructions on when to stop.
  • Discuss the standard length of follow up appointments, the fee schedule and the cancellation policy now so your patient has not only read the intake form with the fees on it, but they have had a discussion with you as well.
  • If the patient has more than one problem and you know there won’t be enough time to assess both problems, ask the patient to pick their primary complaint today. Explain that by trying to cover two conditions in one session, you end up doing less rather than more. Assure the patient you can address their secondary complaint at a later date.
  • Booking appointments: After you have explained your plan in the treatment room and have been clear about timeframes and why patients need to come in at a certain frequency, go with your patient to the receptionist and communicate the treatment schedule that you have agreed upon. If you are busy or the patient needs a specific time, suggest booking in advance to secure the appointments. Re-assure the patient they can change the appointments if needed (with 24 hours notice). Be sure the receptionist gives the patient something (an email, automatic text messages) to confirm the appointments have been booked.

Now that your have set up a way to manage expectations from the assessment, continue to manage the patient’s expectations and satisfaction throughout follow up consults.

Tips for subsequent treatments:

 
  • Structure re-assessments, but don’t go overboard with re-assessments to the point where they consistently sacrifice treatment time
  • When providing hands on treatment, be sure to match your pressure/strength to the client’s tolerance. Ask the client if the pressure is ok, or re-assure them it is ok to let you know at any point if the pressure is too much
  • Ask about the patient’s baseline condition before treatment, then again during and after the treatment.
  • Communicate your intentions with treatment and explain your treatment again if you change the plan. Document this change.
  • Progress the patient’s HEP - It will keep your patient’s motivated.
  • Do not wait till the end of the session to ask if the patient needs anything else. You won’t have the time to incorporate anything new at the end of treatment, so ask during so you can modify the plan and keep the patient happy.
  • At the end of the session, make sure the patient has been educated regarding prophylaxis, their HEP, posture education (if relevant), tape instructions (if relevant), supports/pillows/braces, and any other after treatment advice.

When the time comes to discharge your patient, use this as another opportunity to keep them happy, have them return with new problems in the future, refer you to friends and family, and to give a positive report to their doctor regarding physiotherapy (and help with referrals to you).

Tips at discharge:

 
  • Re-assess their status at discharge and discuss how the client has met their goals. Use your outcome measures again to demonstrate to your patient how they have progressed.
  • If you discharge your patient with a HEP or advice (a good idea!) be sure the information is clear to your patient
  • If the patient was referred by their doctor, write a discharge summary to the doctor so they know you have successfully treated this patient. The more your advocate for physiotherapy and it’s success, the more likely doctors will refer patients for treatment.
  • Re-assure the patient that if their problem reoccurs or if there are new problems, they are welcome to return for assessment and treatment.
  • If you are discharging your patient because they failed to return for treatment, take the time to follow up with them and find out why they didn’t come back.
 

General tips:

 
  • Never ask the patient how they are in the waiting room. If they are feeling terrible, there is no need to advertise this to everybody else in the waiting room. Ask them how they are when you are in more private quarters.
  • If the patient is late, do not say “that’s ok.” It’s not ok, and it creates the opportunity to set up a pattern for tardiness. Instead, say to the patient “come in and we will finish up your treatment.” Then explain that the session will be shorter today because you have another patient waiting

6. Market and brand yourself

Finally, in the competitive private practice environment, it is important to distinguish yourself from the pack. If you specialize or have an interest in a particular area, advertise your specialty.

Have a website, a blog, and all your social media ducks in order. Be sure to post content that relates to your area of interest and your options/methods (your brand) to grow your visibility in the community. Engage your followers with interesting content, and be sure to respond to comments, feedback, and requests.

For more details on how to brand yourself using social media, check out our blog series How to Use Social Media in Your Practice.


Congratulation! You have reached a big milestone in your career! Wishing you good luck, and all the best to you in your career as a PT! Let us know what you're more excited about as you start your PT career in the comments below!

Holly Mitchell BA, MSc(PT)

Holly is a physiotherapist and disruptive healthcare technology advocate with 10 years of clinical experience in both Canada and Australia. She graduated from McMaster University with a Master of Science in Physiotherapy and is on the Embodia Quality Assurance team for continuing education courses. Her area of interest is the connection between planetary and human health and the innovative potential health technology has in mitigating the environmental impacts of the healthcare industry. Holly currently consults with big employers on business opportunities for virtual injury prevention services and industrial sports medicine programs. Her free time is spent figuring out what exactly goes into the recycling bin, chasing her toddler son, figuring out adult ballet, kayaking, and camping in the great Canadian wilds. 

Twitter: @hmitchellTO 

 

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