My Journey: How clinical placement helped to become a patient centred practitioner.

My name is Kostas Kasimis and I am about to finish my MSc Neuromusculoskeletal Physiotherapy course in University of Brighton. I have recently finished my second clinical placement and I would like to share my experience with you.

Before starting this placement I was feeling confident.The experience of my first placement and the progress I made there, added confidence to me as a clinician.Adding to that, the fact that I had already worked with my clinical mentor during my first placement and he knew my strengths, weaknesses and needs as well as the fact that we had worked on fundamental issues already made me feel a lot more secure and at ease. At the same time I was feeling nervous as I knew that the secondplacement, which is the final step before you become an MACP member, would be more challenging and that my fellow student would be a very experienced and skillful clinician. I was feeling that although it would be a tough and challenging experience, it would be a great opportunity to push myself and develop myself even further as a clinician. I felt that I would have the chance to improve my time management, to enhance my clinical reasoning skills and to become more efficient in exploring and addressing patient’s psychosocial contributing factors.

When the placement started I felt much more relaxed. Soon after the beginning of the placement I felt that we were a great team. My fellow student and I were helping each other by giving honest feedback and sharing our knowledge. The observations by the mentor were made in a relaxed way without the “fear” that you are being observed. Sometimes we were discussing during the session about patient’s problem which was great because you had the opportunity to have their perspective and improve your thinking process. I wasn’t nervous any more. I realized that this is a great learning environment for me. Individualized and honest feedback, conversations about our own worries and thoughts, jokes, “games” to facilitate learning and promotion of deepreflection were making the environment relaxed and great for learning. We worked on several different issues that I had to address regarding my clinical practice. I was suggested by the mentor to become less “Greek” which means that I should forget that I am the “expert” and interact with the patient as he was my friend (but always in a professional way). This patient centered approach was different to the approach that I had to my patients in Greece. It was a cultural issue that I had to address. The most important thing is that I managed to do that without changing myself. I found that interacting with the patient in a more collaborative way suits me very well – it was me. At same time I realized that this is the best approach in order to provide efficient management to patient’s complicated problems. I also realized that if you treat the patient like they are “passive” to the expert opinion they remain passive throughout the whole rehabilitation process. If you have them on board from the beginning, if you try to make them feel that they are contributing to the decision making for their problem then they become much more active and they participate actively to their rehabilitation.

Another thing that became apparent to me during my placement was the importance of being flexible and adaptable. I realized that if you are able to understand your patient as soon as possible you can build an excellent rapport with them by showing them a version of yourself that suits them best. In that way, they feel more relaxed and it is more likely to share their thoughts with you as well as give you more accurate information about their problem. For example, it is more likely to build a rapport with a young patient if you use more common language, if you are more laid back and relaxed while you might need to avoid “slang” terms with older patients who appear to be more serious. Similarly,sharing common experiences or interest with your patient might be a good way to enable them to talk more about themselves, about their thought and experiences. This is my understanding from my interaction with patient on placement.

Another issue that we tried to fine tune was that I tended not to put context in my questions or actions during the subjective or physical examination. Sometimes I was struggling to establish a good relationship with the patient or I had poor results on my treatments (or tests)and I realized that was due to lack of context of my questions and actions. I learnt the importance of “taking” the patient with you on the “journey” of the examination and treatment. I learnt how important is for them to know why you are asking all those questions, why you are applying those tests or treatment techniques. It became clear to me that if you prepare them and set them up for what you are going to ask or do it becomes much easier for them to follow the whole process and most importantly to become active participants to that process – you have them “on-board”. Just to add that by explaining and preparing the patient for the upcoming question or action you help your thinking process and your clinical reasoning as well – which I found really helpful. It is like you and your patient think together about their problem. This is really a patient centered care.

I think that the relaxed environment that the mentor created in addition to the thorough and in depth productive feedback that I received by my mentor and fellow student facilitated my learning. I also believe that the deep and honest reflection on my practice as well as the identification of my strengths and weaknesses were the key points that enhanced my learning. Identifying and revealing your weaknesses and being able tohonestly reflect on your own practice might be really difficult in the beginning but soon it becomes the strongest tool that a clinician has in order to keep developing himself. Finally, the fact that I had a great collaboration with my mentor and my fellow student -we were a great team together- added a lot to my learning experience.



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