Plasticity in Life and PT – Input from the Eyes of a Seasoned Clinical Instructor
Name: Denise R. O’Dell, PT, DScPT, NCS
Undergrad and PT School: University of Indianapolis, 1997 (Go Greyhounds! – I really follow the Indiana Hoosiers 🙂 ), University of Maryland, 2009 (Go Terps! – Bummer they’re also in the Big Ten now)
Hometown: Decatur, IN
Fun Fact: I was born during an Indiana blizzard and my father drove an open-air tractor miles the next day to come visit the hospital given the impassable roads – the staff knew I must have been the first born.
Fun Fact #2 – I have been part of a CD recording playing keyboards with Crossview Band.
As a follow-up to my colleague Dr. Andrew Smith’s post, I am in the 5.3% of the population who did not have an injury requiring PT that peaked my interest in the profession. Growing up, I did have cousins in medical professions of PT, OT, and nursing so I did diligence to check them all out. My uncle had sustained a severe TBI when I was a child so I had family experience throughout my life that continued to draw me to this population. I’m honored that he has allowed me to share parts of his story in neuro courses. My parents both worked in education in addition to farming, so teaching was also an early contender.
It was working in a hospital as a tech that solidified my decision – the irony in that influence from my time in the hospital, is that I didn’t know that the holiday and summer vacations my family had experienced during my childhood were not the norm in healthcare. Students, you too will realize that multiple weeks off at the holidays will not be a reality much longer.
Despite my “Little House on the Prairie” upbringing, as my husband from Oakland, California describes it, I experienced different parts of life that encouraged my growth – I sat with my family many Fridays nights for high school football and basketball games (how I learned both the rules of sports and math). This is likely the reason I was quarterback for the victorious Powder Puff Football team and part of my high school basketball team. My family was extremely active in 4-H and I enjoyed showing cattle (but not so much the sewing projects). My opportunities for music ranged from taking piano and some organ lessons from childhood to college, to being part of the “Brave Generation” Show Choir, and eventual multiple praise team groups from Ohio to Maryland to Denver. My 2 younger siblings would definitely say I mastered the art of the “bossy older sister,” but I have always wanted the best for them. I took my first airline flight in high school to Seattle to a “science nerd camp” as my brother put it and experienced life beyond the flat lands of Indiana.
I share my early story as some of you may appreciate that part of my journey. From my time of graduation from PT school, I have practiced in multiple settings – level one trauma acute care, inpatient rehab, hospital-based outpatient care (MSK), skilled nursing facility care and then multiple opportunities at Craig Hospital. My passion and plan has always been to participate in neurologic rehab, but in every setting I have been pushed to build my skills in many areas of practice and – as in collaboration with our manual therapy fellowship director, Cameron MacDonald – we can all benefit from venturing out of our practice silos.
My focus for the remainder of this blog is to share advice as a clinical educator and leader – I have coordinated student programs and held leadership roles in many of the settings I described above. Here are a few tips from my experiences linked to
1. Be Prepared – Whether it be for interviews, a new area of practice, a meeting with a Clinical Instructor (CI) or supervisor, you need to respect the individual’s time that you are working with and come with specific questions or ideas, not just “I need help” or “I don’t know.”
2. Look on the bright side – never expect to have all experiences fall into place. The favorite therapy team I ever worked with was for a community hospital outpatient interdisciplinary department with very diverse types of patients and a fabulous group of people. However, we were all called in for an impromptu meeting one day that our entire hospital system’s therapy departments were being contracted out and we would lose all of our time off and benefits even if we stayed and converted. It was a very challenging time for most of us, but eventually led me to new opportunities in both management and initiating an OP neuro program at a local SNF as well as consulting for an orthotics company and being trained in the Schroth method of scoliosis care including going to Barcelona, Spain. This transition also eventually afforded me tuition reimbursement for my Doctor of Science degree and support for work as an adjunct faculty at the University of Maryland.
3. Always consider others’ perspectives with requests. Respectfully question when you don’t fully understand them or find new ways to improve processes. You’ll learn that there is a lot of gray in the PT field rather than just black and white.
4. Strive for excellence, even in the mundane day-to-day work. remember why you came into this profession and why you want to practice it. Keep your eyes focused on this vision and carry it out to the best of your abilities. Help reignite your colleagues when they might struggle.
5. Take Initiative – Ask questions, proactively seek out opportunities for feedback beyond your CI or Supervisor, as a student intern, humbly let your intent to potentially work in a setting be known before you leave the setting and an opportunity to meet with the decision makers, not just your CI.
6. Communicate if you are struggling and get help – It is important to share if you are having additional life or health challenges with your advisor, CI, or supervisor as much as you feel ready to share. Not communicating when you are struggling often comes across as scattered, not interested, or unprepared. As an early CI, I had a student finally share over half way through a long acute care clinical experience about physical health challenges when we were to the point of action plans and multiple communications with the schools. With earlier and open communication, I easily would have adapted my pace to accommodate her needs and she could have been more successful.
7. Ignatian reflection – Reflect and Journal on your experiences…As I began my journey as a full-time faculty member and part of our Regis Clinical Education Team, I came across my journals from my clinical experiences 20+ years ago. I spent time in Indiana, Ohio, Texas and Washington gaining skills and experience from my patients and CIs that were helpful to review. I also ran my first (and only) marathon in San Francisco.
8. Try something new and test yourself – if you’ve already been in a certain setting, don’t go back simply because you’re comfortable with it. Challenge yourself to try new settings or to work with new people (or move across the country). This will help you to become a more well-rounded practitioner, learn how to problem-solve more effectively, and adapt to different environments, especially when unexpected situations arise (which they will). I moved from Maryland to Denver, single with my chocolate lab, new Subaru and a packed moving truck to temporarily live with my brother for a per diem, no guaranteed hours position at Craig Hospital. Now I have a great husband, daughter, jobs at Regis and Craig and so many outdoor opportunities in Colorado.
9. You are an important part of your team. All CIs and leaders learn from providing education as well. They also learn from you since you have the freshest eyes. Make your time count!
For those of you not as familiar with neuroplasticity, it’s the brain and body’s ability to recover, change, and improve. We as PTs need to also consider being willing to have “plasticity” ourselves.
My Haphazard Journey as a Physical Therapist and New(er) Faculty Member
Name: Andrew C. Smith, PT, DPT, PhD
Undergrad and PT School: University of Washington (Go Huskies!)
PhD Training: Northwestern University’s Neuroscience Program (my department was Physical Therapy and Human Movement Sciences)
Hometown: Seattle, WA
Fun Fact: I do not have a true hometown. I lived in 10 different places by the time I turned 18 years old (military kid).
My exposure to physical therapy (PT) began just like 94.7% of all physical therapists…by a sports injury requiring rehab. Back in 2001, I overheard that many PT schools were shifting to grant the Doctor of Physical Therapy degree. I thought that pursuing a doctorate sounded like an honorable thing to do, so I asked about what to major in for my undergraduate education. My academic advisor suggested either Psychology or Biology. I aced Psychology 101. I horribly bombed Biology 101. Some life decisions come easy. However, as you will read in this blog post, some life circumstances move you in a direction you may not have expected or planned.
Entering into PT school, I was convinced that I was going to work in a private, outpatient orthopedic clinic since I worked as a part-time PT aide for a private outpatient orthopedic company for 2 years. I was tempted to apply for their PT school scholarship with a 3-year service obligation, but for some reason, I decided I would keep my options open. At this time, a major theme emerges – you may be convinced of a professional career path, but life (and God) may very well take you in another direction.
I enjoyed my time in PT school. Finally, instead of being concerned about observation hours, GRE preparation, part-time work, and maintaining a high undergraduate GPA, I could simply dedicate myself to PT school. After exposure to the outpatient musculoskeletal clinic of Seattle’s public hospital, I was convinced that I would work there, practicing PT for underserved patient populations. Again, the theme resurfaces – you may be convinced of a professional career path, but life (and God) may very well take you in another direction.
Along with my clinical rotation at the outpatient musculoskeletal clinic (mentioned above), I also did a rotation at a classic skilled nursing facility (SNF). Although I enjoyed my experience at the SNF, I believed that I was going to work at the outpatient musculoskeletal clinic. This was in 2008, and my wife was entering into her third year of medical school.
So, did I graduate PT school and go work at that outpatient musculoskeletal clinic practicing as a PT for underserved patient populations? Nope. My wife and I moved to Spokane, Washington, for a year, and I signed on with a large SNF company. Again, the theme returns. My wife completed all her third year medical school rotations in one location, and I learned the ropes as an entry-level PT at a SNF in Spokane. As fate would have it, I was the sole PT supervising two physical therapy assistants at that location. I had to quickly get comfortable with patient care and had a trial-by-fire experience, but I wouldn’t change it for anything. The patient population, mostly elderly, was amazing, and I learned so much from these fascinating people. A point here is that SNFs can get a bad rep, but it is actually very rewarding and fun work.
In 2009, we moved back to Seattle, thanks to the large SNF company that transferred me to a location back in Seattle. I worked at a facility where the majority of patients were elderly and of Japanese descent. I am half-Japanese, and I absolutely cherished learning more about the culture and simple Japanese phrases to facilitate patient-interaction. During this time, a position opened up at the outpatient musculoskeletal clinic of Seattle’s public hospital. As underserved medicine was and continues to be a strong passion of mine, I was so excited this opportunity came my way.
Fortunately, I secured the position and was back working as a PT at Seattle’s public hospital’s outpatient musculoskeletal clinic where I originally completed my PT student rotation years before. Here, I grew my knowledge and skills of musculoskeletal physical therapy and my appreciation for underserved patient populations. I signed up for my pension plan and looked forward to working at my dream job for years to come. As the reader might now anticipate…I was wrong. Again, the major theme – you may be convinced of a professional career path, but life (and God) may very well take you in another direction.
In 2010, my wife matched for her pediatric residency in Chicago. I made every attempt to re-create my job situation by applying for a handful of jobs and reaching out to locations, yet no one called me back. Just mere weeks before we moved, I received an e-mail from Dr. Maria Knikou at the Rehabilitation Institute of Chicago. She mentioned a need for a research PT to work with individuals with spinal cord injury (SCI). I had zero exposure to research. I never worked with a person with SCI. So…I was a perfect fit, right?
At the Rehabilitation Institute of Chicago, under the tutelage of Maria, I learned the ins and outs of research. I also worked as a clinical PT at the inpatient SCI floor. I developed a real love for folks with SCI. Despite such a major devastating injury, I am consistently amazed at the resilience and joy that these people display. Here, I also learned that I both enjoyed and had a knack for SCI research. I decided that I needed to become more established as a rehabilitation researcher. A few clinicians in my life were enrolled in Northwestern’s Neuroscience PhD program. They told me that if I get in, if I know who I want as PhD advisor, and have a general idea of what I want to study, then it was a pretty good gig. As a PhD student, I could get a small stipend per year, with tuition waived, and I would not have to withdraw additional student loans. Again, the major theme manifested itself in my life. I studied compulsively, re-took the GRE, and submitted my application.
In 2012, I began my PhD program, and finished in 2016. During this 4-year period, I grew immensely under the guidance of my PhD Advisor, Dr. Jim Elliott. I completed my dissertation using magnetic resonance imaging and both clinical and electrophysiological measures to investigate the disorders of whiplash and SCI. I also continued to work part-time at the Rehabilitation Institute of Chicago, mostly at the SCI floor, and I was able to serve as a teaching assistant for the physical therapy students’ neuroscience courses. I found the blend of research, teaching, and clinical practice to be fitting for me.
So, here I am, a new(er) faculty member at Regis University’s School of Physical Therapy. I continue to work in the realm of SCI research, teach, and am now back to outpatient orthopedic care at our Regis Neighborhood Health Clinic occasionally. I continue to work with underserved patient populations through the Stout Street Clinic and Colorado Coalition for the Homeless.
To all students: I hope my story calms your worries about clinical rotations, as you may find your professional journey ends up like mine – haphazard and not perfectly aligned to your plans. You are entering into a beautiful profession, and one of its redeeming qualities is the flexibility you have within the vast realm of physical therapy. From SNF, to outpatient orthopedic, to inpatient neuro, and to academia, this profession offers a variety of settings to try out and grow into. And if the major theme comes into play in your life…my advice is to enjoy the ride.