A Change in Scenery and Perspective: Serving Rural Communities during Clinical Education

Written by: Andrew Frerich

I was so incredibly nervous before my first day of my first clinical experience. I couldn’t sit still, couldn’t focus enough to do any more last-minute cramming, and wasn’t even sleeping in my own bed. I had talked with some second years students before, and they all told me things like “You’ll be more prepared than you think,” “CIs (Clinical Instructors) always say they are impressed by Regis students,” and “You’re not expected to be perfect, just to know some things and be willing to learn more.” Surprisingly, this logical advice was not winning the battle against the emotional panic going on inside my head. Fast forward six weeks, and my confidence in myself, in my clinical skill set, and in my future was higher than it had ever been.

For my Clinical Education (CE) I experience, I was at an outpatient musculoskeletal (MSK) clinic in Alliance, NE. If you haven’t heard of Alliance, don’t worry, I hadn’t either. However, its rural location helped to make my CE I experience even more enriching. As one of the few physical therapy clinics within 100 miles, we saw all types of patients in the clinic, such as ranchers, farmers, and railroad workers, among many others. We also treated nearly every part of the body; foot, ankle, knee, hip, pelvis, lumbar, thoracic, and cervical spine, shoulder, elbow, hand, plus vertigo, chronic regional pain syndrome (CRPS), and other conditions outside of what you may think of as the typical “MSK” framework. Before I got to clinic, I thought I would mainly treat patients with lower extremity disorders, since those were the management classes I had already completed. I quickly realized that I would have to treat patients with upper extremity and trunk pain as well. In areas with smaller populations, it is not realistic to “specialize” in a certain area, as there are not enough of those cases for one clinician. I got a first-hand experience on how flexible a clinician like my CI had to be, to be comfortable with treating any type of patient that could walk through the door and be able to switch between a lower extremity, a spine, an upper extremity, and a vestibular patient, back-to-back-to-back-to-back.

One of the most satisfying parts of CE in general was getting to follow patients through their journey. I made connections with people as I got to see them again and again. I always asked patients at the beginning of their session, “How have you been doing since last time?” As I formed relationships with my patients, this question ceased to be an attempt to get information for my note and simply became genuine interest in their lives and care for them. I cared for them, and they trusted me. One of the first patients that I saw was wearing a walking boot, and using a walker. By the time my rotation was over, they were walking in normal shoes and almost ready to be discharged. Being able to see the progress a patient could make, a real human, not just a case study on a piece of paper, was incredibly gratifying and really drove home why I chose this career path in the first place.

Aside from that, I felt welcome in the clinic immediately. It was a small clinic with two front office/insurance/PT tech/jack-of-all-trades extraordinaries, one PT (my CI) who doubled as the clinic manager, a PTA who seemingly always had jam-packed schedule, as well as a speech therapist who was only there part-time, but helped raise the energy of the entire building. Immediately, I felt like everyone cared about me as a person, cared about my learning, and wanted me to succeed. With this feeling of support, I was able to set my worries aside and focus on learning and helping patients. As I processed my own feelings and thoughts, I was able to grasp how important it can be to build a positive relationship with a patient. If your patient doesn’t have to worry about if you care for them and have their best interests at heart, then they have more mental capacity and energy to put into therapy and to help heal.

At the end of my six weeks, I reflected on my time as I prepared to return to Denver (a statement that many patients would jokingly grimace at and offer their condolences). I felt lucky to have been at the clinic I was, with the colleagues I had, and to have worked with the patients that I did. Before I left for Alliance in August, I was full of nerves and doubts. As I left at the end of September, I knew that I wouldn’t trade my experience for anything in the world.

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