A reflection on MACP placement learning by Sean Case

Sean Case: identified his pre-placement learning needs and discusses how these were met during placement.

1. Identify and evidence the severity and irritiability of a clients presentation prior to objective examination using evidence from subjective

2. Following the above then identify and be clear about limit of symptom reproduction for all symptoms ie before P, onset P, 50% P, all P

I worked on these two by articulating my thought processes and justifying these to the clinical educator after the subjective ax and before embarking on objective assessment – then depending on the pt or the scenario I might then articulating my thought process during the objective assessment or discuss with the clin ed afterwards about this. Then we would build on this with subsequent visits for that pt. Discussion with the other student also helped this and self reflection.

3. Ensure reassessment of all markers subjective and objective incl functional after intervention and at beginning of subsequent session.

Through discussion with clinical educator and my self reflection I was able to identify the value of this process and how it influenced the progression/regression/adaptation of treatment and also how it helped create a common langauge between physio and pt.

4. As it was an Upper quadrant placement I was keen to experiment with the use of active ULNT as a correlatorry examination to passive ULNT. This was to try and make my assessments more functional and meaningful to the pt.

This was acheived through having the opp0rtunity to treat patients with neurogenic neck and arm pain in a situation where I had time to explore and practise and reflect with other clinicans of greater experience. This type of change of practice whereby I have greater confidence to move away from standard procedures and to adapt and modify according to the pt and their presentation has been one of the fundamental shifts in my practice through the MACP placement process

5. Indentify and consider dominance of pathological presentation under the headings of articular/neuro/myofascial. To then use evidence from client assessment to justify interplay of these tissues in the patients presentation and order of priority for treatment. To utilise this relative dominance to support hypothesis generation but to also avoid closing hypotheses down to soon.

As above having the time and oppurtunity to explore and bounce ideas around with a more experienced clinician as well as the other student helped me develop and learn to keep hypotheses open as well as to re-evaluate as treatment progresses. ( still working on this one – when working with a busy full list it can be easy to slip back into definitive one tissue source mindset)

6. A key learning aim for me in the communication aspect was during the consultation to avoid repetition of statements or constant rephyrasing and to say something ONCE and wait for a response.

Again feedback from other student and Clin Ed help me reflect and develop my communication interactions with patient (and others!)

7. Another key overarcing learning aim was to be more aware of my responses to criticism – ie to be aware of whether I am being defensive or impulsive with responses during post patient analysis discussions or when being confronted by challenging questions about my practice.

8, To be myself and to demonstrate my normal practice

This improved by concious effort as well as through recognising the value of being critiqued. This accepting and opening myself to alternative perspectives and suggestions has made me much less defensive about my practice and reflects a change in mindset from their being ‘one way’ or a ‘right way’ to do things to their are many ways. Importantly by demonstrating my normal practice I am being myself (not what I think the clinical educator wants me to be) and can therefore learn from my actual practice not an impersonation of my practice

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