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10 Ways to be an Excellent Clinical Instructor

by Benjamin Turner PT, DPT

young-woman-doctor-older-man-patient-smiling

As a physical therapist, being a clinical instructor can be one of the most rewarding things you do in a field filled with rewarding experiences. You can have a major impact on the life and career of another person as well as every patient they will come in contact with in their own practice. It can also go really wrong! In my 5 years as a clinical instructor, I’ve learned some things that can make or break a clinical experience. Follow these guidelines and you are sure to have a successful (and fun!) experience with positive outcomes for both you, your clinic, and your intern.

1.Interview your student before their first day

You should do at least a phone interview before your student starts. This will allow you to start to get to know your student and find out a little more about how you can help them to succeed. What are their career goals? If they are looking to practice permanently in your setting great! If they aren’t, that’s OK too, but at least you will know. What kind of experience have they had before? This will prepare you for what to expect regarding the student’s clinical skills. How does he learn best? How about her time management skills? What does he feel like he needs to work on most? What is she looking to get out of the rotation? How would he like constructive feedback delivered? These are all important things to know to help set up a productive and stress free rotation.

2. Know your caseload goals

Before your student comes to your facility, find out how much of a caseload he/she needs to be able to handle by the end of the rotation. This will allow you to set some check-points on or before the first day to make sure you are on track. For a 12 week rotation with a 75% caseload expectation at a clinic that sees 12 patients a day, you could set a 2-3 patients/day mark at 4 weeks, 4-5 patients/day at 6 weeks, 7-8 patients/day at 10 weeks, and 9 patients/day at 12 weeks. If for whatever reason you aren’t on track at any point, you can sit down and figure it out.

3. Have a written plan

  • You can be as detailed as you want, but here is an idea of what we do for a 12 week rotation:
  1. Day 1: 90 minute orientation with onboarding checklist
  2. Week 1: Get to know the flow of the clinic and get used to the EMR
  3. Week 2: Subjective Exam
  4. Week 3: Objective Exam
  5. Week 4: Analysis, Assessment, and Planning
  6. Week 5: Intervention
  7. Week 6: Etc
  • I’ll have my intern helping me treat patients as we go, and depending on the level of the intern, we may speed up or slow down the process. As I get to know what my intern can handle, I will have them work with patients that they can succeed with using the skills that they currently possess.

4. Have scheduled weekly mentorship one on ones

Cannot emphasize this one enough. Having set aside time to work with your student one-on-one is some of the most valuable time you can spend. This allows you to really turbocharge their learning and focus in on the things that they need most. You can plan the material you cover or hit it on the fly, but these MUST be scheduled beforehand or you won’t do it and you’ll miss the opportunity to really make a difference for your student.

5. Give them homework at LEAST once per week

The amount of homework you give will depend on the level of the student. If they are already a rockstar, you may just give them something once per week over the weekend (“write up your subjective exam and be ready to perform it on me on Monday”). If they need a lot of work, you may need to give them something every night (“review your bony landmarks and be ready to show me your goniometer skills tomorrow morning”). This is not to be a jerk, but to help the student to succeed. It’s not your job to teach the student everything he/she needs to know, but it is your job to be a guide to a successful clinical outcome.

6. Don’t try to make your intern a mini-version of you

Remember: You are already a rockstar! You have experience in the field and there is no way your student is going to be able to treat patients exactly like you do. The best way to start a rotation is to find out what they already know and set them up to succeed with their current clinical skill-set. Help them to learn how to obtain information, use the information to make good decisions, and intervene safely and effectively. Put clinical reasoning and principles first. Once they start to show proficiency in these skills, you can start to teach them more strategies and techniques. If you put the cart before the horse, the student will get confused and you both will get frustrated. Build the foundation, the rest will follow.

7. Do daily chart reviews (start of shift)

Daily chart reviews are a must. Make sure you and your student are ready to go 15 minutes before your first patient so you can do a quick run-down of the day and plan for each patient. Ask your student what they would like to do with each patient to get an idea of their clinical reasoning process. Tell the student what you plan to do so he/she can see examples of excellent clinical analysis and decision making. This will also allow you to pick and choose which patients your student will be working with and you can relay what you expect for each interaction.

8. Do daily wrap ups (end of shift)

How did it go? Where did we succeed? Where did we fail? What do we need to work on for tomorrow? What will our homework be? How is the pace? Are you getting enough support from me? What does tomorrow’s schedule look like? Who will do what? This is a perfect time to decompress from a hectic day and get a jump on tomorrow! It will also allow you to make sure that your student is doing well, expectations are being met on both sides, and you’re on track to meet your internship goals. Never miss an opportunity to acknowledge good work and positive behavior.

9. Always set them up for success

Make sure that your student is going to succeed. This means you need to choose wisely what you have your student doing at any given moment. If you have a particularly difficult patient, you should probably not give that patient to your student in their first week. If you can, tell patients that you have a student coming a couple weeks before the intern starts so that they are prepared to have someone else around. It’s a great time to tell patients how excited you are for the coming student and how awesome said student will be. Never force a student to do something they aren’t comfortable doing. This will just lead to a negative experience for the student and the patient they are working with.

10. Have fun!

This should go without saying. Be positive, have good energy, and be excited to have an intern! The more fun you have, the better the learning environment will be. Giving back to our profession and having a hand in the development of another practitioner is an honor and a privilege; make sure it’s an enjoyable experience for all!

If you can implement these ideas, it will go a long way toward a smooth and successful rotation for you and your intern. It is so important for us to shape the path for the next generation of PTs and you can play an integral part. Taking an intern is definitely hard work if you do it right; but remember what it felt like when you were a student. Did you have a CI that made a difference for you? Or a CI that didn’t live up to your expectations? Now it’s your turn to be a mentor for another, and you can do it!

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