fy ‘ aie an’ CuNIcaL EDUCATION 1-pTH6ss Obriowsy 9" . PERFORMANCE ASSESSMENT #1. gy ce tent pas afeel Student name: Alyssa Morley Date of Assignment: 3.18.18 —fAio PA 1s indica trate , For each of the general clinical performance areas listed below. identify hsb sronat br you, af as areas that you feel need improvement. Please refer to the specific course objectives in your syllabus (identified below) as you complete the assessment. Be sure to use your own words, however, versus simply repeating our objectives to describe areas of strength and weakness. Based on your assessment, develop 5-10 individualized performance objectives/goals that you would like to achieve by the end of this course. Be specific and realistic. Make your objectives clearly observable measurable, Attach your goals list to this assessment 1. Interaetion Skills (Objectives 3 a-h.) A. Strengths: ! I think | am consistent when asking questions of my patient for the subjective part of the evaluation. I make sure to get a big picture idea of the patient outside of this specific injury and try to understand how this problem is affecting their life. During the examination, | believe | am becoming familiar and smoother in running through upper and lower quarter screens while giving my patient easy to follow instructions. This helps me keep the process easy for myself and the patient to move through quickly and identify problem areas. 3. Thave become more comfortable in prescribing HEPs. I make sure the patient demonstrates each exercise with proper form, and can ask questions before taking the exercises home. I have also ground some good resources that assist me in ‘making the home exercise program easy to follow for the patient with photos and clear instructions, Areas to be improved: Jn some cases, | focus too much on the pain or the specific problem the patient is referred for, while ignoring other factors. In the case with the posture dysfunction, T overlooked and didn’t ask more about my patient’s home situation to see that her divorce and relationship with her son might be a factor in her stress, not ust her work. 2 I still struggle to keep an eye on my patient's body language and non-verbal cues. ‘There isa lot to keep balanced between watching the patient, organizing all my ‘materials, and watching the patient and their reactions. I know I need to work at making more efficient notes and keeping my attention on my patient and not letting my focus on notes take away from the interaction 3 ‘Sometimes during my examination, I'm clear about what I need the patient to do ‘or how I need them positioned. However, sometimes | forget to explain to the patient the exact region why I am doing each assessment or special test. While it has not been an issue yet, | need to work on explaining to my patient's why | am taking a measure so that they are involved in the process and more comfortable. I. Examination skills and interpretation of findings (Evaluation) (Objectives. 4 a- £,5a-e) A. Strengths: i believe I have become more skilled in choosing special tests or specific measures following my gross screens, 1 am beginning to become comfortable with running through the UQS and LOS to get an overall big picture so that I can see which special tests may be necessary. 2. ‘One of my strengths is that T make sure my patient is comfortable during the entire evaluation or treatment. I try to check in with my patient frequently and make sureML. A. 1 B. O74 they know I am open and they can tell me if they feel uncomfortable or if they Would like a treatment stopped. I also make sure my patient is comfortable in each Position or exam | am performing by having a gown available. Jam becoming more comfortable with looking more broadly t the patient, with the referring diagnosis as my starting point but not the only thing | investigate. I try to always dig a little deeper at my the referral suggests one thing while looking to see if there is another potential cause for their pain or additional problems they might not have put on the referral Areas to be improved: I still have trouble with determining the exact treatment plan for a patient in regard to their prognosis and an appropriate timeline. I am often unsure of how often a patient should be seen weekly and how long is a reasonable estimate for their treatment. often look either too broad, or too narrow. | haven’t found that sweet spot in the middle yet. On some cases, | get too hung up on the initial medical diagnosis and focus too much on that one area, and neglect to notice a secondary issue that may be unrelated to the initial problem I find. Other times, | notice a lot of varying symptoms that do not seem to correlate and have trouble narrowing these down or finding the connection between them all to try and identify specific diagnoses for these multiple problems. I still need to work on the order of my examination procedures. I have gotten better at making sure my patient is not constantly changing position and flip flopping during my exam, but lam not efficient at performing a smooth exam where I'm not stopping and pausing to make sure I want to switch positions or if still have more tests to be run in that position. I also am still working on finding a good rhythm during an exam that helps in my confidence running gross screens while keeping a running list of multiple possible diagnoses and ruling them in or out. Intervention/treatment planning and implementation (Objectives 6 a-i.) Strengths: believe I am improving in creating a treatment plan for each patient. | am more comfortable in finding a problem and identifying what exercise may be appropriate to address this issue while having a backup in case the patient cannot perform that exercise or does not tolerate that modality. | choose my interventions based on the patient, not just using the same ones on each patient. I have a reason for each treatment. am starting to become more routine in adjusting the exam table and my body position for proper body mechanics. It is becoming less of a conscious effort and more automatic to make sure that the patient and I are both comfortable and safe throughout the entire session. I have noticed I make an effort to adjust the table as needed without disregarding this to save a few seconds of time when I could put myself in a better position for my own body safety. often check in with my patient. I ask for feedback after instructions or education on a treatment or modality, and then | elicit feedback during the treatment as well. | want to keep the patient comfortable and involved in the treatments and am open to modifying based on what my patient feels. I also ask if my patient thinks that exercise is doable at home and if they feel comfortable performing their HEP independently. Areas to be improved: [still need to work on critical thinking and determining which exercises might be more efficient for the patient to complete. In some cases, | have trouble selectingan exercise that may serve two purposes, like working on range of motion and Joint stability instead of preforming an exercise that only serves one of these Purposes. I need to explore treatment options to work on what is most effective an efficient for my patient, and start becoming more aware of cost effectiveness for Patients. For my patient that had limited visits, I needed to develop a more comprehensive HEP so that she could maximize her time at home to make the ‘most of our very limited visits | still need to work on the end ofa session with my patient. I still have a more abrupt end to a treatment session as I run out of time for treatment at the end, and I need to keep a better eye on the time to ensure I can close the treatment session appropriately. This would allow me to wrap up a session while giving my patient some time to address any questions or concerns they have with what we did during the evaluation and what to expect throughout their treatment. 3. In some interactions with my patient, | sometimes revert to the mindset that this is ‘my classmate than my patient and feel like | keep my explanations of the ‘weatments vaguer than what a patient may be able to understand. In other instances, | think I give too specific descriptions and give more information than may be necessary which could overwhelm a future patient. I need to work on finding the happy medium of giving a concise summary of what to expect and then elaborate more if a patient seems confused or has questions. sneral problem-solving and clinical reasoning skills (Objective 1 a-c.)*** Note: Refer to early lecture materials in this course on problem solving models and clinical reasoning and decision-making processes to assess this area. What steps in these processes are going well for you? Which ones are difficult2*** Strengths: {am improving at making a mental or physical list of problems my patient has, and what these may all mean. I have become more aware of these possibilities and ‘working on not ruling out something that has not been explicitly ruled out, Thave been working on my critical thinking of not getting too bogged down in the details. In some cases, | get too focused on something that I was not expecting to come up, and focusing on this symptom or finding more than the others instead of taking it in stride to see how this fits in with what other things I am finding. | have worked on taking a minute to summarize all of the things I have discovered and repeating this back to my patient to give me time to put it all together and make sure | did not miss anything, This has helped me see all ofthe pieces at once instead of getting stuck on one symptom. ‘Areas to be improved: In some cases, | have trouble making a decision. | look at all the pieces of the puzzle, and stall out trying to decide on what my next step should be. Ihave trouble deciding if I have done enough tests and measures, if | have asked enough and the right kinds of questions to get all ofthe necessary information to make a ‘well-informed decision on a diagnosis and a treatment plan to address this. 2. In some cases that are more straight forward, like a fracture of the spine, I struggle to make sure to see any other problems the patient may have. I struggle to address their whole body because it almost feels like there is an answer and Tam just verifying this. I need to work on accepting that yes, a fracture might be their main problem, but they may have posture problems or range of motion deficits on other areas due to the fracture or even separate that I can address to get them healthy over all and not just treating the main issue 2. Vv. 2Tnvolvement of p int in decision-making and patient care process (Objectives Zac) ‘ Strengths: { have gotten less uncomfortable asking my patients about their personal life, and Rot avoiding these questions because | feel uncomfortable. I know that these may Seem like areas I can focus less on, but | have realized that the environment a Person is in constantly can affect their treatment and prognosis as much as their A injury can, Thave been working on asking patients what they want to get from therapy, and finding what is important to them about this injury and what they value, | found this has helped me in making sure the goals are something they want to ‘accomplish and will work towards. This I believe will help make sure the patient feels involved in their care and that will motivate them to work hard on their HEP and during their sessions with me. Areas to be improved: | think I need to work on time management. I have sometimes gotten to writing up Patient goals and move quickly through them, without getting as much patient feedback and input as I would like. I want to work on having them assist and work with me to develop goals instead of relying on what they have mentioned to me in the subjective part. My patients will be more involved in their care if Tcan get here to come up with a goal and ask them what they think is doable for them and hat are the things they want to accomplish first and foremost { need to start asking my patients more detailed questions about their values and belief systems. So far it hasn’t been an issue, but I need to make sure that I know ‘what is something my patient might not be willing to do or become uncomfortable with. IFT do this, I will have a better idea of what treatments I might need to find an alternative to and keep these in mind instead of being caught off guard later when my patient does not want to do something. This might be an important factor in my plan of care and I need to be proactive in finding this information sooner rather than later. VI. Flexibility and professional judgment (Objectives 7 a-d.) A. Strength 1 Tam improving in taking in patient information and allowing myself to digest it and mull it over without outwardly reacting. I have been working on being a sympathetic ear to my patients and taking in new information they give me unexpectedly without letting myself get thrown off balance. 2. Ihave been keeping a close eye on my patients and checking in with them often during the sessions to make sure they feel good during exercise especially. | also am mindful of when itis the first time seeing a patient, lam even more attentive when I get them up and moving so that Il make sure they are safe. With a patient L have never seen before, | make sure to guard closely to make sure that I can prepare for an unexpected loss of balance or strength. B. Areas to be improved: I need to be more mindful of or even learn more about different situations that are different from my own, so I can feel more comfortable and not make my patient ‘uncomfortable. The other day I was caught off guard by my patient saying they were homeless and that they had been kicked out of their housing and were afraid to ask for help because they were embarrassed. I stumbled over a response because I had never been in that situation before, and | did not want them to feel jjudged by me because I am there to help, but I also did not know what an appropriate response would be. I did not want to offend my patient by accidentvu. and lose their tru more about thes 24 this is something {feel I can always improve on. To think Won't be 50 ene ations and how I could address them in the future so that | So fat, tha Caught off guard in the future. reimbursement ‘given much thought to many of the social, moral, or legal eon cae issues ouside of providing proper documentation so that I bill can ba wi pnt it up with my notes. Part of this is because with my ee ne cases so far, I haven't faced @ moral or ethical issue head on Uncomforte When that happens the frst ime, {will most key eel to cane at stuale with how to addres itappopriatey. | need to begin re XPlore what situations may aris, and rehearse and think through some Ponses so I can be better prepared when it happens. As it stands, I know it ‘would catch me off guard and I would struggle without a plan in place of how I \Will handle this and what my options are in these situations, Self and peer assessment (Objectives 8 a-g.) Strengths: Thave been working on being very candid with myself through these reflections and making sure | recognize that each case has taught me a lesson. I take this with ‘me when I start preparing for each case to try and improve on an area I had Previously struggled with so that I become more efficient in exams and treatments with my patients. | pay close attention to my peers when they are the PT to try and accurately provide feedback and areas for improvement in the JPR. | also have been working ‘on seeing areas that someone else does ery well in to try and emulate and learn from them in areas where | find | am slow or need to get better at asking about. Areas to be improved: While I notice litle things in my peers performance and my own, I do not seek out feedback. I should start soliciting feedback independently and even when I'm not receiving a JPR. The more feedback, the more I become aware of what I do that m unaware of and giving me help to fix it. I should have created some goals or objectives to complete over this course before formally being asked to do so on a reflection. By doing it on the first day of class or even after the first session, could have take better control over my experience in the class.Alyssa Morley Goals List Self-Assessment 1 f ithin the next ' will finish the subjective portion of an evaluation in 15 minutes within the m two mock cases. { will finish my notes within 48 hours of my mock cases within the next two mock cases, ‘will check dermatomes and myotomes during an UQS and LQS without referencing my notes within the next two mock cases. . Iwill document time increments during my sessions on my notes to allow more accurate billing assessment for my notes within the next 3 mock cases. I will set and review patient goals with my patient before I wrap up my ses within the next 3 mock cases. r | will write my own list of possible diagnoses and then ensure | check each off x only after I have ruled them out with a measure or special test in the next 3 moc! ceases I will stop clicking my pen while I think in the next 2 mock cases.