Week One
I am not quite sure where the last two and a half years have gone, but it would appear I have just completed my last ever week one as a student physiotherapist! These final two hundred hours see me on a second outpatient placement working in a trust I have not previously experienced. The usual unsettling feeling of knowing nothing and feeling utterly out of my depth dissipated quickly this time around. My focus for this outpatient experience is exactly that – to gain as much experience as possible and to continue building up my toolkit. Thankfully, this time around I have my learning from last September to fall back on which has given me a sense of confidence. I feel adequately confident that my subjective assessments are pulling the relevant and appropriate information for me to plan and carry out an objective assessment focussed on the structures I think may be at fault. Phew! Chance then, for me to focus my efforts on the treatments I offer and the caseload management rather than ‘where to put my hands’ or which direction I should face for any particular assessment technique! I must take heart from this, given that not everyone has the opportunity for a second ‘go’ at outpatients. I really enjoyed this area of practice previously and feel lucky to have been given another ’round’! I had forgotten however, just how many questions fill my head with this area of practice. It also makes me acutely aware of the language we, as clinicians, use with patients and what potential impact these can have. I imagine, in these final weeks, I will be turning to the ever-supportive and informative Twitter community for guidance and advice as I continue to forge a path into the world of qualified healthcare.
Evidence Base
Revisiting outpatients for a second time as a student affords me the chance to further explore the evidence base for 
the treatments available, in turn, helping me to choose as well as enabling me to provide treatment choice to my patients. Whilst it is my clinical reasoning that will arrive at given treatment choices, I am aware that the patient should be included in this decision-making process. Without their input they are no more than a passive receiver of information and advice; I want to help people to help themselves with guidance and support. I wish to promote self-efficacy and empower my patient to feel confident and able to achieve their goals. I hope to focus my efforts this time around on exploring the clinician-patient relationship and the factors that can influence it. I have been signposted to the flag system already this week in conversation with clinicians about chronic low back pain. Whilst I am clear on the red flags and aware of potential yellow flags, I have little knowledge of other levels in the system. I have a genuine interest in motivators, facilitators and barriers to patient concordance and a wish to help those I treat. By broadening my awareness of these, perhaps I will better equip myself to recognise them and in turn overcome them in partnership with the patient. Idealistic perhaps? Well, I am a firm believer in modelling my behaviours and practice from ideals. I have a strong sense of what I want to achieve by joining this profession; I care and I have compassion. If I can make a difference to someone, however small, then I have achieved one of my goals.
Observations
I talk here of observations made of me in practice, by my educators, rather than the objective observations we make 
as clinicians. This first week has felt wonderfully frustrating – I can say ‘wonderful’ now after much discussion with peers and family members, processing my thoughts and associated frustrations. As I moved through week one I detected a sense of irritation at the constant monitoring I was under. Every patient I have seen has been with my educator present, sat conspicuously in a corner attempting to make their tunic blend into the decor behind! A swift “ignore me, pretend I’m not here” from my educator, addressed to the patient and I would carry out my appointments. Inside I was feeling disheartened by their presence, imagining all the permutations for the reasons why perhaps they were scrutinising me so closely. Might they be doubtful of my skills or knowledge? Had I unwittingly given cause for concern in some way? Perhaps they had even received prior warning I was unaware of!? I was baffled but continued silently in my frustrations, deciding it was better to ‘put up and shut up’ than seem like a problematic student in week one! By Friday, I felt ready to explore their thoughts on progressing me to more autonomous practice, with perhaps windows of time alone with patients. It was well received and I was assured that week two would see me given more space and freedom. A well-timed discussion on my part or a decision that had already been made on my educator’s part I will never know. However, from this I have affirmed how important effective two-way communication is and that in fact people, generally speaking, are not mind readers! I have also learned, perhaps, a more pertinent lesson. I can remember clearly the feeling of utter terror when told I would be alone with a patient for the first time in an outpatient setting back in September. I knew I had to make the leap but felt hideously ill-equipped to ‘go it alone’. This time and with five months extra studies under my belt, I feel eager to move into more autonomy – a wonderful signifier that, maybe, I will soon feel ready to qualify. When you consider the timeline in front of me, it is all rather timely and fortunate in fact, as soon I must! My only hope is that next week serves to reward my search for more freedom and I am not faced with the most complex patient that ever existed!
PHYSIOHEAD 