Thirteenth Week - Rapport

Dunedin weather continues to offer four seasons in one day. More wet and cold than sunny and warm at this time of year. We've had hail, snow, gusts and rain over the week. Typical Dunedin rain is misty-drizzle which is ideal for using umbrellas because the rain falls straight down (little/no wind). Last weekend the rain came in thick and fast - two minutes without a rain coat and you may as well go for a dip in the sea with your clothes on (although the rain is not salty!). Not only are 'wets' walking the streets (wet people), they are lying in their flesh for us to examine in our anatomy lab (wet specimens / cadavers). How was that for a topic switch to anatomy?! We finished anatomy for the semester with urogenital and gastrointestinal systems. The lecture on Monday had phrases like "we'll look at the perineal region from the bottom up" (i.e. looking at the inferior surface... this is anatomy humour!). We continue anatomy next semester with the musculoskeletal systems. No doubt the workload will be similar and more hands-on. That's my 10 cents worth in!

PHTY254 continued with chest physiotherapy and associated techniques. Medical imaging is an important role of diagnosis - as such, we must learn how to interpret x-rays. In addition, we were busy percussing chests (a clearance technique this time, not the assessment technique), huffing, coughing, applying manual vibration to the chest and positioning one another for optimal drainage of different branches of the bronchi/passages of the lung. I'm ready for the next wave of the flu now!! The public will be happy that we practice these techniques on fellow students first; the percussion technique uses cusped hands rather than flat 'slaps' - practising on classmates is quality assurance for you! We also learnt the pursed lips breathing technique - you may recognise this as a similar technique ('fish face / kissing face') females use in photos posted on social media! If only they knew how useful it was for persons with COPD. ...no I'm not going to take a 'selfie' of this technique to post here!

My tip for surviving physio is thus, always warm the diaphragm of the stethoscope before touching the patient - nobody likes cold hands either! To maintain good rapport with your classmates, warming your hands before 'patient contact' is essential! (Especially if they've just walked in from the cold outdoors!)

I  found another physio student blog, but this time it is from a past student of the School of Physiotherapy (Otago University): http://mariansphysioblog.wordpress.com/

Today was my last musculoskeletal placement for the year at Dunedin Hospital Outpatient Clinic. The most important thing I have learnt over these three placements is to establish good rapport! From the moment the patient enters the clinic we need to create a positive experience for them. Without this, treatment outcomes are not likely to be as successful. We certainly don't want to make the assessment/treatment process any harder than it has to be - after all, we need to enjoy being physiotherapists!

Dunedin Hospital

With no more lecture slides - it's time to revise! Building rapport with ourselves is important too! We don't have to (but can it we want to) medic in the next few weeks due to up coming exams. The team physiotherapist will cover for us. By the end of next week I would have done three out of five exams - I'll let you know how they go!

A few treatment areas of the Outpatients Clinic

 

Twelfth Week: Team Work

The kidney filters your blood volume ~30 times every day - that's around 180 litres!

"Think of a hypotonic solution like soup...  but you take out all the salt - which pretty much leaves you with just water..." - A part explanation of the leaky-epithelia working to re-uptake water within the kidney (n.b. urine is not soup!)

Team work was the key to our PHTY254 group presentations on Tuesday. Each group had slightly different aspects of their condition to address, but the idea was to give a 15min presentation on our designated condition / case study. My group was given 'obesity and the metabolic syndrome'. We made the presentation exciting by pretending one member of the group was the client in the case study. I ended up with a pillow under my shirt and a class mate on my back as I preformed part of the Harvard Step Test. In total I was shifting a mass over 140kg to help the class visualise some of the limitations of an obese individual. Other groups presented on osteoporosis, myocardial infarction, multiple sclerosis and diabetes. Recent PHTY254 lectures covered chest physiotherapy, that is; spirometry, reading chest x-rays, reading ECG and chest auscultation (listening to internal chest sounds). We'll get to practice all of these in the labs before the semester break. This week it was just spirometry, percussion (as an assessment technique, rather than a treatment technique), measuring chest expansion (with our hands as well as a measuring tape) and vital signs.

Last week I mentioned that my placement group worked as a team to complete a subjective assessment - this week was no different. Our clinical supervisor is great! If we complete a detailed subjective assessment, she allows us to proceed with an objective assessment and create a treatment plan (all with the patients permission of course) - we are only limited by how efficient and effective we are at the assessment process. Physiotherapists are like investigative journalists or criminal detectives in the way that our subjective assessment works to reveal the specific problem within the context of general health and psychosocial factors. The pathology is usually like a stereotypical criminal; sneaky, deceptive, causes mischief and more often than not needs to be rehabilitated before being allowed to reintegrate back into society. Anyway, we had our notebooks out taking a group subjective again. This week I was given the social history and I done a brilliant job! Only one more week at the Outpatient Clinic to go! Where has the time gone?!

There is a written component to placements. We are expected to complete a SWOT analysis, clinical diary and self-reflection form. SWOT is an acronym for strengths, weaknesses, opportunities and threats. One of these is completed before and after a clinical placement. This encourages us to be self-aware of the above points and plan to minimise weaknesses and overcome threats. Clinical diaries allow us to record conditions we've observed or treated and self-reflection forms allow us to reflect on the experience - these are completed after each day of placement. In addition, the supervisor may ask us to re-familiarise ourselves with content or to research a condition or technique.

I haven't mentioned sport medicing in a while, but this week was particularly exciting (but not because it fits perfectly with the theme 'team work'); the team travelled to Alexandra (2.5h drive from Dunedin) for a match against the Queenstown team! Road trips are always exciting and Alexandra is in a beautiful part of Central Otago, New Zealand! Tech won 9 - 0!!

Eleventh Week - Placement

We begun a new series of physiology lectures on renal (kidney) function. The lecturer utilised clickers to enhance the learning experience (the yellow remote control-like device, left image). This engaged the audience in a 'game-show' of renal physiology MCQs (multi-choice questions). Rather than announcing individual winners, a poll of submitted responses were shown and the actual answer was highlighted. Good fun!

The last physiology lab looked at the electrical and mechanical events of the heart using ECG, pulse transducers, sphygmomanometer (BP meter) and stethoscopes. As you would expect, the events of the heart adapt to different conditions, so we tried a few different conditions (lying vs standing vs exercise) and discussed the mechanisms behind what we observed. In the right hand image, if you look closely you will see some of my own heart electrical rhythms on the screen (the top line is the ECG recording). ECG leads (and electrodes) require accurate 'placement' (positioning) on clients. The imaginary line between the placed electrodes either side of the heart provides information about that particular plane only. This is why a client may have up to 12 leads placed to provide a more complete picture of what is occurring in the heart.

As if we didn't have enough fun with physiology this week, I dusted off my 'exam kit' for our second mastery test on Wednesday evening. This test covered content about: special senses, respiratory, cardiovascular systems and some neural systems content. Thank goodness this was also MCQ.

The staff at the School of Physiotherapy are very friendly and personable people! A few staff even stop to chat when we happen to see each other around Dunedin / the wider community. One of our lab demonstrators from PHTY254 and PHTY250 (anatomy) seems to have successfully memorised most of the students in our year group!!  That's around 100 students, and we are only nearing the end of the first semester - I haven't even said 'hello' to all the students in my year group yet (let alone, know their name by face).

The highlight of my week happened on Thursday - clinical placement! My first physio placement was at the Dunedin Hospital Outpatients Clinic. I have a placement there for the following two weeks too. This is primarily a musculoskeletal service. The placement involved a quick orientation of the physiotherapy outpatient area of the hospital followed by a quick recap of underlying pathology of the knee - and then we had a patient to interview! We were thrown right in to the mix from the get go! As the patient entered the room we were quickly allocated a section of the subjective assessment to take. I was first up. I had to note the 'presenting problem' and fill in the associated body chart. I found this quite difficult, but done an alright job. When I got stuck, my supervisor stepped in to help out. I actually wrote very little on the body chart because I couldn't multi-task. This is certainly something for me to work on next time!!

Tip for surviving physio: have a notebook to document different things you learn/observe, any homework tasks your supervisor gives, and as a resource to notes - like steps of a subjective assessment. Also, it pays to practice assessments on friends and flatmates - physio student's need plenty of 'patient mileage' (practice)!

Hospital staff and health professional students need ID!

There are two more weeks until the end of semester one! (I feel like the count-down has begun). So, here are some more song parody clips, but this time they're from medical students. Although med students will eventually provide a different role in the healthcare service, there is a lot of content overlap and we generally have similar attitudes, workloads and interests. These clips have good entertainment value. Enjoy.

It is hard work being a health science student, but there is always time to positively reflect on their experience and enjoy the process.

Tenth Week: Practice

Practice is the repetition of a task over a period of time and can be used to learn, improve or maintain a current physical or psychological variable. There are many methods to modify how an individual practices - this is important to know as physiotherapy practitioners. Depending on the treatment goal, physiotherapists usually give patients exercises to practice (as a patient, it is wise to adhere to these). Patients may be asked to practice strengthening, motor control, stretching and/or breathing tasks. The phrase 'practice makes perfect' is not always true, but it sure can help. Subsequently, this week a classmate and I practised (on Monday) for a mock exam on Tuesday - the real practical exam will come at the end of semester one. Mock exams enable us to quantify how much and specify what we need to study. The practical exam requires each student to perform one therapeutic task taught in PHTY254. We were not told which task we needed to preform until five minutes before having to demonstrate the task. In that five minutes we need to prepare the equipment and environment. Also in that preparation time, it is important to recall details about the task (because the examiner will scrutinize your method and therapeutic rationale) and to be able to adapt it on the spot if prompted by the examiner (they like to put us on the spot). The assessment must be done professionally, as if it were a clinical situation (...introduce yourself, gain informed consent and thank the patient afterwards, etc). After the mock practical exam, I figured that I was on track and needed to revisit righting reflexes observable in balance examinations. I will have another practice closer to the practical exam.

A classroom used for PHTY254 at the School of Physiotherapy

PHTY254 content took a shift from musculoskeletal techniques to cardiorespiratory. Our lecture and labs covered risk stratification given the presence of risk factors or disease. The lab centred on quantifying body composition, so we were busy pinching each other's fat folds with callipers!! I bet you're imagining what number would come up if you were measured right now. Not to worry, there is a large amount of error when novices measure. In my previous Physical Education (Sport Science) degree, I became certified with the International Society for Kinanthropometry (ISAK) so currently my skill level is still above that of my classmates (but they gave me some nice numbers, which I felt happy with given my current level of physical activity). They'll get better with practice!

My 3rd year physio flatmate also asked for an opportunity for her to practice her manipulation skills on my thoracic spine. It was brought about by a conversation at lunch where she tried to get me to practice my subjective assessment on her. When she hinted that she was keen for a participant to practice manipulation on, I took the opportunity to volunteer and we raced down to the physio clinic lab rooms for her to practice. Apparently there are a few methods to manipulate the spine. Whatever she done, released the nitric oxide, making the popping noise - success!! I felt fine, and we continued separate ways to our own labs that followed. I look forward to learning these skills next year!

Even the skeletons are sociable!

Social events continue to take place. For the next fortnight the annual Otago University Students Association (OUSA) Capping Show is being performed. This is a theatrical production set to offend you and make you laugh. The 2014 theme is 'A Capping Carol: The Night Before Hyde Street'. For those who are not familiar with Hyde Street in Dunedin, it is a common venue for recreational couch burning (usually put out by the fire service and you may be arrested by the police) and once a year it is home to an all day street party for thousands of dressed up students.

Another social event [taking place next week] is the 'Inter-faculty Stein' - this is a health-sciences student organised drinking occasion / night out. Students are encouraged to dress-up in their faculty colours (Dentistry = white, Physio = pink, Pharmacy = green, Medicine = blue) and party! I think I'll pop along to this one!

  
In-class events next week: The second physiology mastery test, our last physiology lab on cardiology and I begin clinical placement next week. I am placed in the outpatient clinic at Dunedin Hospital. There will be plenty to discuss next week!

The faculty event this week was an information day for first year health science students. Physio students and staff were on hand to answer any questions they have about choosing a career in physiotherapy.

My dentistry friend and I made a weekend dash to Wanaka to climb a mountain!!

I've put in some video clips that I have found to be interesting. The first one is on physical activity, the second one is on stress.

That's all for this week... back to the books!!