Mentorship is a concept that has been used universally in the development of all different types of healthcare practices.
To advance as a clinician, you must improve your critical thinking skills. Having sound critical thinking and clinical reasoning skills makes the difference between keeping patients safe and putting them in harm’s way.
Learning to become a physical therapist requires full immersion and engagement in practice. There is a large amount of research showing the importance of mentorship in a clinician's development.
We are hyper-focused on mentorship
Unfortunately, a new grad may not always have access to an official mentorship program, or may be part of one that is inadequate. In physical therapy school, I was reminded continuously by professors and by my fellow classmates of the importance of entering a mentor program and/or residency.
Furthermore, the concept reverberated through my conscious each time I looked at the Facebook group "Doctor of Physical Therapy Students." People would post about their mentorship experiences and gush about how much they learned and progressed as clinicians.
Programs themselves would send me information through the mail. My pile grew larger and my patience grew thin. Upon graduation, I was again reminded of the focus on mentorship when many of my classmates went on to attend a residency, or find employment in other states that purported to have mentorship programs in the first 6 months to 1 year of work.
Mentorship can be expensive
I took my time to decide my move before I graduated. In all honesty, it took me until after I graduated to decide my next step.
I weighed the pros and cons of this decision. Not only would participating in a residency or sanctioned mentorship mean less money, but it also included a lot of time and effort. I started to realize that the learning just starts when you graduate.
Additionally, the first 6 months were a huge learning curve, not only in regards to a caseload and clinical skills, but also in regards to finances. Financial literacy becomes a large part of career and professional decisions.
For many new PTs, myself included, this becomes a big cloud over our shoulders. Do I sacrifice time, money, and maybe even a big move across the country for a residency or mentorship? Or do I find a way to become better on my own, in my own way?
I decided to steer clear of residency programs due to the potential loss of income and/or even paying out tuition for a year or more of didactic studies and 1 on 1 mentorship time (Touro College’s Orthopedic Residency is $820/credit for an 18 credit program = $14,760). This cost would be on top of my previous student loan debt. The idea of going into even more debt was definitely not on my agenda.
I believe this is the case for many individuals, both new grads and experienced PTs. People may have families to support or additional debt they are dealing with. Others may just not want to go through a residency at all.
Make sure mentorship is right for you
Residency programs are rather demanding. It is necessary that you know whether you are still capable of being mentored and if it fits into your life.
There have also been individuals who pick their place of employment based on the promise of mentorship. They then find themselves with a program that lasts only a few weeks, or maybe with a weekly agenda that falls to the wayside when things get busy. This leads to a mentorship program that is inadequate.
Individuals involved in these type of situations find a way to learn, despite the lack of mentorship. Also, there are a limited amount of residency programs and official mentorships for specialties that are less common (CCS, PCS, WCS), yet people in these specialties eventually become skilled experts.
In this article, I am not stating that mentorship, or lack thereof, is a good thing or a bad thing. My goal is to give the new grad advice on how to improve clinically when residency or official mentorship is not an option.
This article delves into 5 methods that a new grad PT can use to improve clinical reasoning skills WITHOUT going through a residency or an official mentorship program.
Method 1: self-study and reflection
In order to improve your clinical skills, you must first ensure you have the knowledge to back up your reasoning. This is achieved through self-study and reflection.
Doctor of Physical Therapy students are taught the importance of evidence based practice and reflection in practice. They learn how to comprehend research statistics, levels of evidence, and strengths of methodologies. They are also taught how to use this knowledge in practice (potentially).
Yes, life can get busy and the stress of the clinic can leave people with mental fatigue. However, if you are someone who is yearning for knowledge and is seeking to improve your skills, there are a plethora of resources.
The benefit of learning on your own is that you can explore different ways of thinking. You can also go through difficult concepts on your own without help. Self-learning also benefits those who might learn at a different pace than a mentor wants.
Self-study is also one of the most important ways to go about preparing for an exam. When you are studying by yourself, you can actually take some time off and take breaks so that you can get back to your usual self. Self-study may either be studying books, reading online journals, or watching webinars to learn a particular topic.
Self-study, when done correctly, is a very effective learning tool, so it can be helpful when preparing for a test or when learning an entirely new subject on your own.
All you need to do is draft a schedule and start working towards your goal in a systematic way. Do not add up sky high study hours - this is bound to stress you out. Keep it straight forward and distribute time across subjects evenly.
Benefits of self-study:
- Freedom to learn without any restrictions.
- Learning at your own convenience.
- You find what works for you.
- Explore different ways of thinking.
- No fear of criticism.
- You can make study material on your own.
- You gain self-confidence.
- Self-study is basically taking in information, processing it, and retaining it - without the need for any other person to be teaching or evaluating you!
Here are a few ways to improve your effectiveness with self-study:
- Make learning your lifestyle.
- Since you don’t have a classroom to keep you as focused as possible, you have to create your own studying space (look here for help). It’s important to organize a desk for that purpose. Get a comfortable chair, a laptop, the books and notebooks you need, and some pens/pencils/markers. As soon as you sit on that chair, your mind will be prepared to commit to the goal of learning.
- Highlight important facts or conclusions so you can find the salient points if review is necessary.
- Do not just read - you also need to review!
- Take notes.
- Teach others.
Here is a list of great online continuing education programs:
- Modern Manual Therapy
- Mike Reinold
- Allied Health Education
- At Home Seminars
- APTA Read for Credit
- PT Webucation
Reflection is not an abstract concept. It is an important tool in the practice of physical therapy.
Self–reflective abilities can be nurtured into habit. What we reflect on, how we reflect, and what happens after reflection can vary. Reflection can occur when a learner reflects on an individual, group, or organizational aspect of clinical practice, education, policy, or research. It can also occur when a team reflects on how it functions as a group.
Using simple tools, such as questionnaires or reflective essays, to assess the process of reflection might only capture part of the process. Therefore, the process should not be abandoned for the perceived lack of a robust measurement.
It is important to incorporate activities that foster reflection. Although learning portfolios or reflective essays are the obvious activities to consider, there are other options available (e.g. reflective log sheets, case-based discussions).
Method 2: colleagues and conferences
Collaborating with colleagues
Face to face interaction and communication is a large part of physical therapy practice. This is not only happening in the clinic with our clients, but with our colleagues as well.
I have seen many practices that have up to 8 therapists working at one time. These individuals have varying amounts of experience with different patient populations. One might be a pediatric specialist, another uses yoga/pilates in their rehab protocol, the next might have more manual therapy experience.
These are individuals to bounce ideas off, to learn from, to converse with, to study with, and debate with. Working with colleagues whom you have a great work relationship with can actually make work fun and improve your passion for the field.
Devote a portion of your day toward relationship building, even if it's just 20 minutes - perhaps broken up into five-minute segments. For example, you could pop into someone's office during lunch or ask a colleague out for a quick cup of coffee.
These little interactions help build the foundation of a good relationship, especially if they're face-to-face. Additionally, this facilitates a more direct route of communication when clinical issues arise. You have now found an outlet to learn from others.
Attending professional conferences
Live events—conferences, workshops, lunch & learns–provide unique learning and career building opportunities that you can’t find anywhere else. These events are a place to learn from the leaders in the field. These individuals will present their most recent research, explain their own clinical reasoning, and facilitate discussion with the audience to promote a better understanding of the topic at hand.
The idea is that sometimes you have to take a break from the “work” of your work to sharpen your skills. A dull axe won’t cut a tree nearly as effectively as a sharp one. I always return from a conference with new ideas and approaches that make me more effective and efficient at work.
Don’t be the woodcutter hacking away at the tree with a dull axe, while your competition cuts it down in half the time with a sharp one!
The problem with the web is that we now believe everything is at our fingertips. And maybe it is. But there’s an overwhelming amount of data that we often can’t crack, or that keeps us from the best material. A well-run conference will help curate new ideas to help us improve our approach.
It’s easy to read a blog post from the privacy of your own office. You won’t break a sweat listening to a podcast (unless you’re on the treadmill). You don’t have to make small talk while your YouTube video loads up.
While there are those among us who are born networkers, live events can be a challenge for many of us. However, breaking out of our comfort zones is just the type of action we need to take to break out of old ways of thinking.
Whether it's on the expo floor, or just at a few tables near the coffee and muffins, companies often have tools to display that we haven’t seen yet. There may be a new app that make us faster, less prone to costly mistakes, and gives us a unique edge over the competition.
While these products can be found on their websites, it’s great to get a hands-on demonstration or be able to ask questions that are specific to your business struggles to the company itself. Additionally, there’s nothing like being in a room of like-minded people. Other people who are willing to take time away from the office to learn something new. Other people who want to “better” themselves.
Here is a list of conferences that can help refine your skills:
- Combined Sections Meeting (CSM) - next one is in New Orleans, LA from February 21-24th, 2018
- NEXT Annual Conference and Expo
- National Student Conclave (NSC) - for students who want to pursue their own self-development before graduation
- World Confederation of Physical Therapy
- APTA Annual Orthopedic Section Meeting
- Yoga and Physiotherapy Congress
- 5th International Conference on Physiotherapy
- Private Practice Section Annual Conference
***Local regional/state chapters of the APTA tend to have symposiums or in-services that involve physical therapists in the professional association and its chapters. For example, here is a calendar of events from the NYPTA.
Method 3: continuing education courses and networking
If we are to believe Socrates, our educations are merely the kindling of an eternal flame. The practice of physical therapy is constantly changing. Continuing education (CE) is required for clinicians to stay current with the latest developments, skills, and new technologies required for the field. The quality of patient care and general public health are enhanced by evidence-based medicine.
Currently, there are many CE courses that are available online. However, there might be a time when that is not enough to fully solidify the material. You may need a human body to actually learn the skills being taught.
There are many orthopedic physical therapists who rely on practicing techniques that require psycho-motor skills. In-person continuing education courses allow the individual to be observed, albeit for a short time, performing a skill set. The instructor may give advice on hand position, amount of force to provide, and even clinical pearls as to how this technique can help a certain population.
Furthermore, there are also courses geared towards pediatric specialists who might want to perfect their Neuro-Developmental Treatment (NDT) skills. This is another psychomotor skill set that may require an experienced instructor's eye to determine if it is being performed correctly.
Many of these continuing education courses are provided by companies/schools of thought that boast their own system of clinical reasoning (e.g. finding the comparable sign in Maitland-Australian Physiotherapy Seminars). This is the most important part of taking the courses. Concepts, skills, techniques, and evidence are presented in varying degrees. A course may even delve just into the business side of physical therapy. It is all about keeping an open mind and soaking in as much information as possible.
Both CE courses and conferences are prime time for networking. True networking occurs when there’s an understanding that everyone in the room has equal value. In its purest form, it’s about people enjoying other people, communicating passion, and connecting with others who share those passions. It’s about listening, figuring out what others need, and connecting them with people you think can help - without any designs for personal gain.
These events also open up a plethora of individuals who you can brainstorm with about a difficult case. The larger your network, the more likely someone is willing to help. In a sense, it is like many other aspects of life - a numbers game. Here is a little pearl of wisdom I have learned from my encounters with colleagues and other healthcare professionals:
Here is an alphabetized list of physical therapy certifications. This article also provides the websites from which you can research various continuing education courses you find relevant.
Method 4: “unofficial” mentorship
In some ways, finding one individual to “officially” mentor you can be self-limiting. Most people seek out mentors by looking for a formal relationship (e.g. residency, fellowship, or employer program). However, more often than not, this doesn’t lead to the kind of relationships and growth they are hoping for.
I have several people who I receive advice from and I may label them as “mentors”, but I don’t meet with any of them every week — or even every month. For the most part, I see my “mentors” 1-2 times a year. I found these individuals through my clinical rotations, through my schooling, through the workplace, and through CE courses/conferences.
Physical therapists live busy lives and the best ones live even busier lives because of the knowledge they possess and hopefully want to share. These relationships develop over time. Do not expect that someone will drop everything just to take the time to teach you.
If someone is an expert at something, odds are they like talking about it — so send them an email with your question. Getting an email back could be the ticket to learning something new that can take you to the next level, even without ever talking to this person face-to-face or on the phone.
Be prepared for the encounter. Push the boundaries of your thought processes and find those areas you feel are lacking. Write these weak areas down, so you can have an effective conversation when you get a response.
You should also write out the questions you want to ask, so you don’t waste time or miss anything. Write down more questions than you think you’ll have time for, so you are prepared to make the most of your time. Think of follow-ups, potential pitfalls, questions about their personal experience, and anything else you can think of to make sure you get the most valuable information possible.
So stop looking for a long-term commitment or an official “mentor” and start building a network of people you admire. Start having conversations with people in this network and soak up those mentorship moments. It will take you so much further.
Method 5: trial and error
Another concept that was introduced while I was in school was how to become an expert clinician. My classmates and I always joked around when our professor said “10,000 hours.” We acted that way because some of us were trying to cope with just how much time it would take to become an effective clinician (we were also making fun of how specific this time frame was).
The path to learning a skill is often long. It is not always an easy task to undertake. You have to commit yourself to the task.
The trial and error method is about diving into your subject and learning how to work your way through the system. It is characterized by repeated, varied attempts, which are continued until success or until the individual stops.
Imagine being a person who doesn’t know how to swim who has to jump into the middle of a lake from a helicopter. Your goal is to reach the shore. To succeed, you need to learn how to swim while you’re in the water.
Some would say that this approach is primitive, labor intensive, and can give the practitioner a false sense of competency. However, I find that treating each encounter with a patient like a science experiment is the ideal approach to the traditional concept of trial and error. It will show you how important it is for you to undertake a structured approach to practice. If we can learn from our own experience effectively, we can handle increasingly more complex stuff.
To further support this method, neuroscientists at the University of California, Berkeley conducted a groundbreaking study where they captured brain images of active learning (trial and error) in real-time by photographing the brains of mice as they learned how-to problem solve through trial and error.
Although this is an animal study, the researchers believe these findings provide compelling evidence that supports the benefits of "active learning” (trial and error) in schools and workplaces.
Active learning is an educational approach that advances critical thinking and problem-solving by doing an activity, while simultaneously thinking about the task at hand. The objective of active learning is to optimize cerebral (of, or pertaining to the cerebrum) thinking and intellectual capabilities by doing an activity.
Another benefit of the traditional trial and error method is the ability for an individual to attain an even more effective and efficient way of learning. Insight learning is a type of learning or problem solving that happens through understanding the relationships of various parts of a problem rather than through trial and error.
Motivate yourself from within
I believe the biggest driver in improving your own clinical skills comes from within. It is your motivation. Generally speaking, motivation is what energizes, maintains, and controls behavior. Motivation will most likely lead an individual to work harder, create an environment of success, be more quality-oriented, engage in self-improvement, and foster efficiency and effectiveness.
The individuals I look up to have a palpable passion for the profession of physical therapy. They really love the profession and its effect on an individual's health. They are constantly learning about the human body and they embrace the challenges that come along with this great profession.
These individuals strive to get better through internal motivation (it is ingrained in their thoughts and actions). They are not solely motivated by money or power. There is more to practicing physical therapy than that.
Ask yourself why you entered this profession, and try to focus on the aspects of PT that resonate with your own values. And then once you do it – once you determine those things – I’m certain that you’ll find other people who are infatuated with the same things.
Please let us know if there are other methods you have used to improve your skills!
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Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287(2):226-35.
Kolb DA. Experiential learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall, Inc; 1984
Ménard, L., & Ratnapalan, S. (2013). Reflection in medicine: Models and application. Canadian Family Physician, 59(1), 105–107.
Johnson, C. M., Peckler, H., Tai, L.-H., & Wilbrecht, L. (2016). Rule learning enhances structural plasticity of long-range axons in frontal cortex. Nature Communications, 7, 10785. http://doi.org/10.1038/ncomms10785