Episode 25: Students are NOT free Labor!

The goal is to learn , inspire and bring cardiopulm to the forefront of conversation . Thanks for joining me today and let's get after it . Hello , hello and welcome to another episode of Talking All Things , Cardiopalm . I am your host , . I'd like to take a moment to highlight our sponsor , Jane .

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You can also use code Cardiopulm1MO at the sign-up of for a one month grace period on your new Jane account , a small gift from Jane to you . So here in Kansas City we've had about a week of unbearable heat and in between that heat we've had some pretty aggressive storms . People have been out of power for a few days . Actually we were lucky .

We are lucky Power lines are underground so we made it out unscathed . But it is storming again today . So if you hear the sump pump going , if you hear the rumble of the thunder , that is what's happening here . Also , I am in a long sleeve in the middle of July .

So today I want to talk about students and the student experience , and I feel very strongly about this experience , being a PT , being a former student and just being someone who enjoys teaching and mentoring .

I've had a lot of former students reach out who are out on clinicals or now new grads , and the common denominator sometimes is they feel like they're free labor , they're not actually being mentored , they're not learning on the job . The main goal seems to be this level of independence , right Meeting entry level .

So I have a lot of comments to kind of make around this , but I wanted to start out with the definition of a student . What does the word student mean , and it's actually very simple , and I have three different citations here , so I'm going to read them to you . The first is from Webster A student is one who studies , an attentive and systematic observer .

Student is a systematic observer . They're not an expert , they're not entry level , they're an observer . Dictionarycom says a student is a person formally engaged in learning , especially one enrolled in a school or college , a pupil , any person who studies , investigates or examines thoughtfully .

I love all those words Oxford Dictionary says , denoting someone who is studying in order to enter a particular profession . I think this is perfect to combine with that systematic observer , an investigator and someone who's examining the technique in a thoughtful manner , especially one who is becoming a physical therapist , a PTA , whatever field you are in .

And then I decided to also look up the term intern , because I can already feel the arguments coming back to me . Which is the reason why you're on this clinical affiliation is that you are preparing to be a physical therapist , so therefore you need to be able to show competency and entry level , whatever that means , right ?

So I looked up the definition for intern and I also like this one .

This one's from Webster , and Webster says an intern is an advanced student or graduate , usually in a professional field such as medicine or teaching , gaining supervised practical experience , as in a hospital or classroom and I love that definition because those are the words that I want to hear more of Supervised gaining practical experience .

The whole point of going on a clinical , an affiliation , an internship , whatever word you want to put around it the purpose is to gain hands on skills .

The purpose is to tie your didactic classroom information to real life Into , from classroom practicals , where you might be working on other students , to an actual patient , and you don't just go from the book to the patient .

The clinical , the internship is meant to help develop that student , to teach them hands on skills , and that should start with some level of observation . Yes , every student is going to come with a different level of experience , especially if they're a first year versus a third year 100% .

Students are going to come with different levels of confidence 100% but at the end of the day , there should be some strategy to taking students .

Food for thought If you are in a hospital setting , in an outpatient clinic , home health , whatever setting you are in skilled nursing facility across the board , if you are a facility that is taking students , you might want to consider having a group , a meeting , a committee dedicated to what that experience looks like .

So not every experience is wildly different from the next , because obviously different CIs are going to have a different teaching experience . That's fine , that's great , it's what makes the world go around . But maybe there should be some expectation , maybe there should be a lead-in process .

Maybe we can give the students a moment to observe how you perform an exam , how you perform a treatment session , so that they have something to base it off of . Most of my student experience comes in the acute care setting and I 100% stand behind the statement , that is , students in the acute care setting should not be left alone .

Those students should not be treating independently . It's kind of like patients , right ? If you're an acute care therapist , how often do you truly write that person is independent ? You technically can't if you're supervising , right , like if you're at a supervision level , x number distance apart .

They've kind of changed some of the verbiage over the years , or at least in Epic they have . But if you're there , is that patient fully independent ? That's kind of how I feel about students . You should always be nearby , line of sight .

You know how you watch your patients , who are in the bathroom who really want their privacy and independence , and you're that creepy acute care therapist with your eye between the crack of the door . That's how we need to be SCIs , because what happens ? If something happens , the acute care setting can change in an instant Period .

You should at least be nearby , so if something goes wrong , you are witness to it , you're able to observe the student's decision making and you can step in if you need to . It is unfair to put the student in that position to make high level critical decision making skills on them and , by the way , it's under your license .

I feel strongly about this because I see it often and I feel like I hear more negative stories about students' clinical experiences than positive ones , and to me , this is like the perfect scenario . Yes , you may not be getting paid , I get it but you're paying intuition to have this experience right .

So we should be giving them an experience and that experience should be learning . If you're a PT right now and if you're someone who takes students and you're a CI , I want you to think and reflect just a little bit .

Think back to the time when you were on a clinical fill and think back to your worst experiences and your best experiences and then think about what made them the worst and what made them the best . And then think about you , think about yourself .

Self reflection is 1,000% necessary in this life and if you are a teacher , a mentor , whatever you want to call yourself , we have to self reflect . And no , we're never going to be perfect . But maybe you should ask yourself how do you teach , how do you create , cultivate this experience for the student ? What things do you do well ?

Are you creating good , beneficial learning instruction for your students , or are you taking eight weeks break Because the students basically doing the work ? Lots of variability , and I can't speak specific to any one place because every place is different .

So I'm going to try to hit a different couple of different things , and this is my opinion and it also reflects state practice act type verbiage , medicare type verbiage , cpi type verbiage , although I have my qualms as well . But if you are taking a student , in no situation should you have a full patient list and your student have a full patient list .

It makes no sense . What is that student getting from this experience ? That is free labor , giving a student a full list , expecting them to carry a full case load , while their instructor also has a full case load In the acute care setting .

What that might look like is the CI and the student being in completely separate areas of the hospital , completely separate floors . I personally think that's unacceptable . Now , if you had one case load and it was split between the student and the CI and that split starts to change over time throughout the weeks , that makes more sense .

That also allows the opportunity for your student to observe you . How do you handle this situation ? We can extrapolate from experiences . Oh , this is how Rachel handles this . Oh , this is how my CI did that . Let me try that and then allow your student to make it their own .

The other side of the coin is the CI , who wants the student to be exactly them , and that's just not possible In life . That's not possible . We are very different people . We have different personalities . I could never expect someone to say something exactly how I said . I also wouldn't want that .

You have to be able to make it your own and I'm speaking to the student there , but also the CI . Allow your student to make it their own . The goal is to teach them skills , to teach them hands-on skills , to teach them how to adapt and deal with what's in front of them , and if they never see you do it , how are they going to learn this ?

If they're out on their own treating , then how are you going to know how they handle that by the note that they wrote ? I mean , think about it . We have to be able to cultivate a good learning experience for our students so that they are ready and entry level at the end . We can't just expect them to be 100% independent Period .

We have to be teaching , cultivating , asking questions , challenging them In real time or outside of the room . We should be debriefing . We should be talking about our plan before we walk into the room and then debrief after or at the end of the day or whatever your schedule allows .

But there should be some opportunity to have structure , to have observation , to create a plan , to learn how to adjust when the plan goes right out the window because you know it will and then debrief on how it actually went . There needs to be feedback , there needs to be learning . There needs to be the ability to help the student become more efficient .

They don't just do it by being thrown in the situation Sink or swim . That's a really shitty teaching technique and if you've ever been on the other side of that . It's a really shitty place to be in . So how about we do better for our students ? How about we help cultivate good experiences so they can become good therapists ?

I was going to tell a story from when I was a student . I was like maybe let's tell it . I had an affiliation where I was with three other students from my class and we had three separate CIs or four separate CIs , I should say . And the way that this facility worked , it was a skilled facility . It was like skilled slash acute care .

It was a little bit of both More skilled than acute . But you hear what I'm saying . I'm trying not to call any specific place out .

They broke down their patients by floors , which I thought was odd , but like whatever . So apparently my CI's floors were packed and therefore our schedule was packed , and the other students who were in my class were all in the same grade . Their floors were light , so they saw maybe one to two patients a day .

They were told to act as my aide , which I was very uncomfortable with , and my CI packed my schedule and he wanted to be done by two o'clock every day , even though we ended at 4.30 . So I had to pack the whole day before one o'clock so that I could write my notes from 1 to 2.30 . And there were multiple patients coming down at the same time .

The other students were just sitting chit chatting , bullshitting with their CI and my CI was nowhere to be found . So essentially I treated an entire caseload independently by myself , probably against every state law , insurance law that existed .

And when I spoke up and said number one I can't take more patients and number two , I would like more supervision , I got kind of attacked in the sense that I was told I should never say I can't take anymore because I'll get fired from my first position . And this was one of my last of fills . So as a student I sucked it up and didn't say anything .

But in retrospect I 100% should have been talking with my school and getting involvement , because none of that was okay . So I left that experience with a bad taste in my mouth . This is what my career is gonna look like . And there was a safety issue that happened along with that . I had a patient . I was doing stair training with him .

He was a bigger gentleman and we made it up one step and he buckled . I caught him . He was sitting on my leg , I had him secure with the gatebelt and I calmly asked for assistance and everyone ignored me because they were just shooting the shit off to the side .

And then I eventually got a little bit more aggressive with my ask for help and then they realized oh shit , here's the student who's been treating independently this whole time , who almost has a fall , but doesn't , because I was attentive and aware and in good position . But what if I wasn't , then what ? So let's not have the what if it goes .

Bad experience , what if ? Right , the what if ? Is a scary place to be . How do we prevent that ? What if this happened ? Be there , be present , be teaching , be supervising , give feedback and please give constructive criticism , constructive feedback . This is an important one because , again , no two students are the same .

If you have ever been a coach , you know this . You cannot coach two players exactly the same way . Some people need direct information , some people need it a little bit more softly , and you have to learn your student and you should ask them how they best receive feedback .

They're learning styles , because not every person is going to take your feedback the same way . So learn their style a bit . Be able to adjust . That's what makes you a good teacher . Okay , full caseloads . Let's talk about full caseloads . This is another thing that drives me like wild . In order to be entry level , there's a statement about percent of caseload .

You should be able to be able to maintain this percent of your CI's caseload . You should be at 100% of a full caseload by this time . That's arbitrary . It's such arbitrary bullshit that I can't even begin to wrap my head around how that's a primary component in the CPI . First of all , every setting is going to be different .

Every CI is going to be different . My commentary back to that is do we care that the student can handle a max caseload but they're not safe ? Do we care that a student can carry a max caseload and we're not providing good intervention ? Do we care that they're at a good case load ? Full case load and their assessment skills are crap On top of which .

What is a full case load ? If you go into an outpatient clinic , that might mean 40 in a day . That's unrealistic and a poor expectation to set out period , let alone having a student carry that out . What is a full case load ? It is an arbitrary statement . So , instead of being hung up on , is my student 100% at full case load .

How about we think about is my student safe ? Does my student make good clinical decisions ? Is my student capable of changing the script when things don't go their way ? Is my student able to communicate appropriately with their patient ? I mean , sometimes I just I don't know . I think we get caught up on the wrong things .

A student is at a clinical affiliation to learn that setting and we have high expectations for students because think about it . Think about if you were a new hire , or think about when you were a new hire . Think about how many weeks it took you to be completely independent . Now again , same thing . This cross the board is different .

Right , it's not the same in any two places . I was in the acute care setting and I was literally thrown in the deep end . Singer swim , no floaties on good luck . Other people have a better onboarding process . They learn how to use the systems . They have to pass their competencies . They have someone supervising them on the unit .

They're taught the protocols of the specific surgeons at that place . You're like three weeks out before you're like maybe left on your own . These students are here for eight to 12 weeks and we expect them to be fully independent . Stop it . We need to be teaching them so that on that last week or the two weeks leading up to it , they're my eye .

Right , they're basically independent , but I still have an eye on them . I still wanna make sure that they're making good decisions , but it doesn't mean I'm going to see my own caseload . So this is my opinion . I think we need to be better educators across the board , at all levels of affiliation in DPT school , in residencies and fellowships .

I've done that, right . I was a resident . I taught in a residency . I did a residency because I never had a good mentor . I never had someone take me under their wing and say this is an option on how to do this . Now make it your own . This is how you articulate better . This is how you approach this situation .

I shouldn't have had to wait five years into my career to get that . That's what an affiliation should be . That's what a new grad should get when they get hired in . You can't expect someone to be 100% independent when they've never done that thing before .

And then the last thing I think , the last thing I wanna say is stop projecting your shit onto your students . I'm sorry , I'm like cursing today , but here we are , it's true . Yes , there is a ton of burnout in the profession of physical therapy . Yes , there are a ton of stereotypes for every setting that exists . Yes , there is salary gap issues 1000% .

I live it every single day , I know . But don't project the shit onto your student . They're ambitious , they are new , they are starting out . If you wanna give them practical advice , give them practical advice , but don't give your hate and burnout to them . It's unfair .

Let them make decisions so that they can have a great career or they can choose to be in the setting that you hate to , whatever it is , but stop projecting that onto them . It's terrible .

Yes , there are things there are 1000 things that I can complain of and rattle them off pretty quickly , and if you get 10 PTs in a room , I guarantee you that conversation will come up at some point . But guess what ? There's also a lot of great things to our career and part of it is how we personally take control of it . Control of it .

Yes , you can be in a mill and see 60 patients in a day and never actually treat a patient or know your patient . Yes , that exists . Yes , you can work in an acute care hospital , have 23 patients on your list , expect to see all of them , and maybe the most that you do is get to a chair and walk . Does that stereotype exist ? Yes , does it happen ?

Yes , but do you have to be that PT ? No , and you can choose to not be that PT or go to a different place if you are unhappy with what you have .

But there are a lot of wonderful things about PT , including the versatility of our career being in different patient populations , being able to go into different settings , being able to be PRN at multiple settings . You don't have to pick .

And just because you don't, I know I've said this before, but, just because you don't like something , don't project that onto your student . The number one advice I give to every student I have ever met is keep an open mind , see as much as you can and figure out what you like and what brings you passion , what fires you up , because something will .

And guess what If it doesn't ? If you try it and you don't like it , you can change . If you do something for 10 years and you no longer like it , you can change . But you're always gonna have the ability to have a good job , to make a salary , to have benefits . It exists .

So just because you are physically unhappy in the setting that you're in or the job that you have or the supervisor that you have , whatever else is going on , don't project that onto your student . It's unfair . And I'm not saying lie to them and tell them it's all roses and it's easy peasy and we're all making six figures . No , I'm not saying that .

I'm saying don't project the negativity onto them . Give them hope , give them the ability to make good decisions . Give them practical advice , not your own problems with whatever you have . I see it every day . I hear it from my former students and it makes me upset because this is my profession and I'm still passionate about this profession .

And , yes , I have lots of qualms , and one of which is how we speak to each other and how we talk about ours specialties or whatever , and that we're competing amongst each other instead of elevating each other , elevating our students , being proud of our profession . I understand that not everyone is made to teach or coach . I know that .

I understand that in some settings you don't have the option to be a CI or not . You just are given . I understand that supervising someone for 12 weeks takes a lot of energy . I do . I was a mentor in a residency for four years .

That is one to two residents for an entire year with one week off , and then you do it again , and we had occasional DPT students in there as well .

Being a supervisor , being a mentor , being an educator , means that you have to be on in some way , shape or form that you are teaching , that you are challenging , that you are showing up in a certain way I don't even want to use the word professional , but that you're showing up in a way to support that student . That is your job in that moment .

I understand that takes a lot of emotional energy . It takes a lot of physical energy . It can be difficult If the personalities don't jive . It can be difficult , but you still want to cultivate that experience so that we are helping to elevate our profession and teach our students to be the best version of whatever PT we're trying to establish .

If you are in a facility where you take students , self-reflect a little bit . Think about what you like about having students . Think about what's a sticking point for you . Then reflect back to the time when you were a student . What was something good , what was something bad ?

What was something that you really remember , that you hung onto Good or bad , and then fix it . The problem is when we keep repeating the cycle . If you have the ability to break a cycle that is endlessly repeating itself , break that cycle . Make it better .

If you're in a facility that takes a ton of students , maybe gather a group of people who really enjoy having students and create some sort of onboarding process so that every student has a similar expectation in the sense of learning , the systems , documentation , all the things that are different about your facility than other places and what that experience might look

like . It shouldn't be cookie cutter . I'm not saying that . I'm saying that there's an expectation , and it also takes the reinventing the wheel out of the picture Every time you have a student . We shouldn't be reinventing the wheel . There should be a process , right . There should be some sort of communication . There should be some .

Hey , why don't you look these things up before you come to our facility ? These are the primary patients that you're gonna be seeing . This is the documentation system , whatever . Get it going before they're even there . So there's an expectation . I love to teach , I love to mentor , I love to watch the transformation .

I love to figure out how to adjust to the person in front of me . I enjoy that piece that everyone does and that's okay . If you don't love to do that , then you have to figure out how you can collectively get through the 12 weeks and still make it a good experience for both of you .

There's one more piece that I wanna talk about and that's the student piece , the student perspective . If you are a student and you are listening , this is specifically for you . If you are out on clinicals , allow yourself to learn . Be the receiver of the information . Allow the feedback . It isn't always easy to take feedback .

Trust me , I have lived it , I have taken it . I've gotten aggressive feedback . I get it . Articulate how you like to learn . Articulate how you like to receive feedback . Step one try to keep an open door of communication .

But , most importantly , understand that the feedback that you get , if you can take it , run with it , make improvements that will make you better . Don't take it personal . Use it to your advantage to become a better student , a better therapist .

If you go into every affiliation thinking you already know everything , thinking you're already independent , thinking you are already a PT , you're not going to get the most out of that experience .

Learning is a two-way street you have to be willing to accept the feedback , willing to accept criticism , willing to learn , keep an open mind , ask questions and , if you are unsure of something , ask for help . I think sometimes that is part of the problem .

If students aren't asking for help , the CI thinks that they're fine and they just keep moving in this parallel universe without anyone knowing that they need something different . So communicate , be willing to learn , be willing to accept feedback and get the most out of every experience you're put in .

I say it to all my students and colleagues You're part of the equation . If you want to have a good experience , if you want to learn , if you want to maximize the place that you're in , you are part of that equation . You have to make an effort as well .

You have to be willing to do things differently , to be willing to articulate , to communicate , to learn . Every experience is what you make of it . It's something that I truly believe , and if you don't put that effort in , you're not going to get it back . Are there things outside of our control ? Totally ?

Do we sometimes end up with a shitty situation , a shitty CI , a shitty setting , whatever ? Yeah , it happens . It happens all the time , but for the most part , we have some level of control and we are part of that equation and we have to maximize that experience to get the most out of it .

And just a little sidebar If you're out on clinic , use those cases . Write them up , obviously in a nondescript kind of way . Use those cases to help you study . Use those cases to break down the , to break down what assessment techniques you're gonna use . Build your cases for study techniques later for the MPTE .

Every experience that you're put in is going to help you in your future , if you allow it to . So , students , you are part of the equation . Make sure that if you want to maximize your clinical experience , that you are also asking for help communicating , allowing yourself to learn and going in knowing you're not gonna know everything and that's okay .

That's the point . Fun fact , you're never gonna know everything , trust me . 14 years in , I learned something new every single day and that is a lot of work . That is what I love about this profession and that's what I love about learning and that's what I love about teaching . It's a two-way street .

If you let it be , if you are a student , if you're a CI and you have any commentary , please let me know , reach out . Hopefully this was helpful

for you . Kind of felt like I was a bit on the tangent , I don't know .

Felt like the Italian New Yorker was coming out and maybe I was yelling a bit , so apologies if you felt like I was yelling at you the whole time , but I feel strongly that we need to prepare the next generation in a good way , in a way that's gonna help them thrive in this profession , in a way that's gonna help us make our profession better , because they're

coming up behind . Right , we have to plant the seed , we have to cultivate the experience so that the outcome is what we expect and that outcome is fun to watch . And maybe that student ends up being an employee at your place . We don't ever know what that future holds , but what we're doing in this amount of time can help cultivate what comes next .

All right , I hope that was helpful for you . I may have looked at the end , so I'll double check that on the editing and that's all I got for you . So if you have any questions , if you have any commentary , please reach out on Instagram , email , on text message at 913-308-4494 .

I hope you all have a wonderful day and whatever you have to do again after it . We'll talk to you there . You , you you .