Final Entry

Well, my rural placement is over and I had an absolutely fantastic time. I was exposed to many, many new situations and learnt so much from my supervisor and all the other health care professionals that I associated with over the 5 weeks. My initial feelings about being nervous continued well into my first week, but by about my fourth day I had found my feet and these feelings eased off considerably. This was my musculoskeletal placement, but being in a rural setting meant that I gained exposure to many different aspects of life as a physiotherapist, including in-patient hospital treatment, neurological disorders, cardiorespiratory disorders, women’s health, orthopaedic conditions, home visits, group exercise classes, paediatric and plenty of gerontology patient experience as well as musculoskeletal conditions. I also treated a cat, which was interesting to say the least!

My main concern in my initial entry was that of the perceived heightened expectation of me as a 4th year student, which turned out not to be much of an issue at all. On my first morning I asked my supervisor if he would mind if I just observed him when taking the first few patients of the morning so that I could get an understanding of how he goes about his business in the musculoskeletal setting, because I had very little experience in this setting. He did not have a problem with this, but insisted that once I feel comfortable and ready that I let him know so that I may take over. This worked very well and by the third patient of the morning I gave my supervisor the nod and I was away. My other concern about my supervisor not making an allowance for my feeling of being a ‘slow starter’ also proved to be incorrect as he was more than happy to facilitate my initial style of learning and any other learning styles that I requested throughout the placement.

From this point onwards I was relatively independent with my patients, but my supervisor was always around to provide support and suggestions if ever I needed it. As time progressed I got more and more exposure to different patients and scenarios and required less and less input from my supervisor. The initial thoughts about not currently having the capabilities of a new graduate we correct during my early days and my supervisor admitted this at my end of placement assessment, but I feel I progressed and continually challenged myself to grow to point where I feel I would now be working at a new graduate level in musculoskeletal physiotherapy.
My final concern was that I initially viewed the musculoskeletal as 4 very different entities and this was still evident in my mind until the end of my first week when I treated a patient and it all seemed to ‘click’ for me. The concept of remote mechanical problems became very clear from a practical perspective in my mind, not just from a theoretical perspective. I treated a patient who had definite median nerve compromise symptoms in one arm, showing sensory changes in the median nerve distribution in the hand and weakness of the thenar muscles. The nerve was very sensitised on palpation of the nerve in the cubital fossa in the forearm, but the patient was complaining of symptoms in the shoulder on upper limb neurodynamic testing as well. This finding led me to assess the shoulder and in turn the cervical spine, which produced the exact same symptomatic findings in the shoulder and hand upon PAIVM assessment of the lower cervical spine. I was sure there was compromise occurring at the intervertebal foramen at this level, which was causing the problems, which did end up being correct. I also assessed the thoracic spine to see if it was a further contributing factor and sure enough it was incredibly stiff, so I concluded that the apparent lack of movement here was being compensated for in the cervical spine with increased movement and causing compromise of the nerve root. My diagnosis was proven correct when I mobilised the thoracic spine and mobilised the cervical spine into the opposite the direction and gave the patient a stretch to open up the IVF on that side as a home exercise program and he returned the following week virtually symptom free. This piece of the jig-saw had fallen into place and from here I didn’t look back.

This placement far exceeded all my initial expectations and I really cannot believe how much I got out of it. My supervisor was amazing with every interaction that I had with him, which made me so much more confident that all my actions were becoming better and better. As I said previously, I feel that in the space of 5 weeks I have gone from below par in the field of musculoskeletal physiotherapy to the expected or even above expected level for a new graduate therapist.