It is difficult to only look back on the past year of being a student physiotherapist. Especially when it has taken 4 years of absolute hard work, perseverance, strength and determination to get to this very point on which I reflect upon today. Every experience from the very first day that we stepped into this university until now has shaped us and lead us to today. Of course, nothing can beat that nerve wrecking yet exciting feeling of your first day at a clinical block. To be honest, I don’t think any amount of time sitting in a classroom can prepare a student for what that first day feels like. Although, I do believe that we would not have survived the big world if it weren’t for the strong foundation that was instilled in us during class times. According to Grace and Trede (2013) learning something in a classroom and applying it in practice it is two completely different things and one could actually say that this is the most challenging task for students.
During ethics lectures we would always engage in such extended and stimulating conversations. You could tell that everyone was captivated by the stories and wanted to tackle the ethical discussions to “find a solution” or “the right answer”. However, when you actually are faced with such ethical situations you realise, there is never a perfect approach to these dilemmas. The way you thought you would have handled it is somewhat different to how you practically did handle it. Skøien, Vågstøl and Raaheim (2009) say that this involves the idea that students enter a complex and relatively unknown world of social and cultural reality in clinical practice, and this poses different rules from that of academic education. Therefore, applying theoretical knowledge into practical skills and action does not become a simple task (Skøien, Vågstøl & Raaheim, 2009). I recall a day in class when we had an intense discussion about child abuse. If you read my previous blog post “Cast a Broader Net Than to Miss Catching a Child at Risk”, you will understand why this topic intrigued me.
The blog post briefly discussed the concepts of recognising child abuse by exploring a personal ethical situation which was experienced in clinical practice. Lazenbatt and Freeman (2006) states that recognising child abuse is a complex and difficult task for health care professionals. There were so many factors in that practical setting which shaped my decisions and guided my actions. It was the not just about what was clearly in front of me but about the interaction of myself with those around me. Skøien, Vågstøl and Raaheim (2009) identifies learning is a response to social interaction rather than something that takes place within the individual. It is the participation in social, professional and cultural relationships which influence students’ professional development (Richardson, Lindquist, Engardt & Aitman, 2002). The way I approached the ethical situation in reality would not have been the same as if I sat in a classroom discussing it
How would I have learned what to do when faced with this complex situation, if I were never to experience it? How would I have been able to acknowledge that this in fact was a very complex situation, if I were never to experience it? Can I confidently say that I now know what to do when faced with something similar to this, because I have experienced it? In my opinion I have gained valuable insight on this topic as a result of my experience and critical reflection process. The video below illustrates a simple example of how experience can aid a person’s growth and development.
I want you to swap out the characters in that video to the characters in your clinical journey. Picture yourself as the child, the mother as our lecturers and the market place being parallel to our clinical environment. If we analyse the video above and identify it in terms of physiotherapy students in clinical practice, we can imagine how the reality of the clinical world has become our evolving professional and educational canvas. Delany and Watkin (2008) explain that the main focus of clinical education is experiential learning. Were students are exposed to a range of scenarios and conditions initially through observation followed by supervision in clinical practice (Delany & Watkin, 2008). Ernstzen, Bitzer and Grimmer-Somers (2009) state that the clinical learning environment creates a contextual opportunity to facilitate professional skills among students. Lindquist, Engardt, Garnham, Poland and Richardson (2006) also mention that development of a physiotherapy student’s professional identity is fostered by an authentic experience in clinical practice.
There are rumours of a particular clinical block, in which the clinician is never there and you basically have to take complete charge of the physiotherapy department. Well, this was no rumour as my last clinical block was at this specific placement and the whispers were true. I was fortunate enough to have a fellow colleague with me during this block which was in all honesty something I preferred. Skøien, Vågstøl and Raaheim (2009) explains that the presence of a fellow student allows students to express their feelings about clinical practice, help each other, share responsibilities and have someone to call upon when uncertain. Although we were allowed to approach our clinician with questions and clarification, the clinician was never in the department to guide us, watch us or teach us. The only time we had guidance was during clinical supervision and it was during these session were I grovelled for interaction.
In my previous blog post “Professional Identity” I mention that I admired the clinicians I worked with as role models for the professional I strive to be. Grace and Trede (2013) role models are powerful influences on developing a sense of professionalism. The clinicians and supervisors guided me and in a way nurtured my development throughout my blocks. Lindquist et.al (2006) explain that purposeful mentorship of physiotherapy students is considered to promote development of an identity which incorporates the deep understanding of professional principles and skills. However, I did not experience this embracing clinician presence at this block. This caused me to question my ability to cope on my own but it also assured me that it was possible to succeed. This block became the trial for our soon to be qualified experience. It felt as though it was the ultimate test of my transition from student physiotherapist to physiotherapist. Did I consider myself professional enough to take on this role at the department? Has my growth in my profession over the past year prepared me for this block? Have I developed enough as a clinical professional to engage effectively in the clinical world? Would I be able to take on the challenges faced and how would I go about doing so?
According to Grace and Trede (2013) professionalism is a complex and multifaceted concept which evolves with ongoing learning that will mature with experience. They continue to say that the role of experience, participation, life-long learning and reflection on professional experiences appear to be the core component in the process of becoming a professional. It would be misleading to believe that professional identity development is static and that professional values learned are set in stone (Richardson, Lindquist, Engardt & Aitman, 2002). It is this very statement that leads me to understand that my experiences over the past year which shaped my professional identity is constantly being written. I had to accept that I was and always will be learning on my own and in collaboration with people around me in order to mature my professional identity. I have not yet become the great people I have observed but I know I have come quite far from the first thought of wanting to become just like them. According Lindquist et.al (2006) professional identity development is of a dynamic and transformative nature.
I wrote a blog post titled “Start Drawing a Line” to describe the boundaries that exist between a health professional and a patient. In this particular post I also explore the topic of sexual harassment of a physiotherapy student by a patient with reference to a personal experience. In this last clinical block I had again experienced a form of sexual harassment by a patient. While I was treating the patient who experienced groin pain, he would make repeated and on-going sexual comments which made me feel exceptionally uncomfortable. I initially ignored it hoping he would stop, but when he continued, I proceeded to explain to him that he was being inappropriate and that he should stop. I did not feel comfortable treating him the next time he came and I asked my colleague if he would please take over this patients sessions. Weerakoon and O’Sullivan (1998) state that health professionals are able to recognise behaviours as in appropriate however, do not label them as sexual harassment. This was true for me with my initial experience, but after careful and critical reflection of that experience, I have become more aware and empowered about such situations. My response during this situation was stronger, clearer and more evolved compared to the situation in my previous blog post.
Shapiro, Kasman and Shafer (2006) state that the reflective writing process has important potential uses in educating students. Through writing, students think about personal situations and contemplate their own reactions to those situations from a subjective and indefinite vantage point (Shapiro, Kasman & Shafer, 2006). I feel that if I did not engage in the writing process through blog posts, I probably would not have evaluated my ethical and professional experiences. If I did not do this, my approaches to reality situations would somewhat be unchanged from classroom discussions .To critically reflect on these clinical experiences over the years has forced my mind to understand and unpack certain situations rather than to just accept it as is without learning from them. Delany and Watkin (2008) express that although clinical experience is dominant in educational learning, it might not be enough to meet the needs of health professionals. This is why critical reflection is adopted as a way of thinking and a process of analysing practice that facilitates students to learn and develop their professional identity in an ongoing way (Delany & Watkin, 2008). They go on to say that the role of critical reflection as a component in clinical education is an important and necessary core framework to understand and deal with the dynamic and complex environment of clinical practice.
Physiotherapists, who develop a strong professional identity that embraces the concept of life-long learning and a willingness to adapt throughout their professional career, will be better prepared for constant change and growth (Lindquist et.al, 2006). These words will become an echo throughout my journey of professional development which has not yet ended but is continuously changing. If I look at this big picture, the little girl in the market place, the physiotherapy student in a clinical environment and take a step back to marvel at its enormous canvas. What do I see? Is this a simple painting of a series of events over time? Or do these simple series of events tell complex and riveting stories? Every single aspect of this clinical journey has played a unique role in building the professionals we are today, and will continue developing into throughout our careers. We have evolved in ways we never thought we could and to understand that is to fully embrace the fact that everything that has happened in the past years have lead you to this very day.
Delany, C., & Watkin, D. (2008). A Study of Critical Reflection in Health Professional Education: ‘Learning Where Others Are Coming From’. Advances in Health Sciences Education, 14(3), 411-429.
Ernstzen, D., Bitzer, E., & Grimmer-Somers, K. (2009). Physiotherapy Students’ and Clinical Teachers’ Perceptions of Clinical Learning Opportunities: A Case Study. Medical Teacher, 31(3), 102-115.
Grace, S., & Trede, F. (2013). Developing Professionalism in Physiotherapy and Dietetics Students in Professional Entry Courses. Studies in Higher Education, 38(6), 793-806.
Lazenbatt, A., & Freeman, R. (2006). Recognizing and Reporting Child Physical Abuse: A Survey of Primary Healthcare PProfessionals. Journal ofAdvanced Nursing, 56(3), 227-236.
Lindquist, I., Engardt, M., Garnham, L., Poland, F., & Richardson, B. (2006). Physiotherapy students’ professional identity on the edge of working life. Medical Teacher, 28(3), 270-276.
Richardson, B., Lindquist, I., Engardt, M., & Aitman, C. (2002). Professional Socialization: Students’ Expectations of Being a Physiotherapist. Medical Teacher, 24(6), 622-627.
Shapiro, J., Kasman, D., & Shafer, A. (2006). Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education. Journal of Medical Humanities, 27(4), 231-244.
Skøien, A. K., Vågstøl, U., & Raaheim, A. (2009). Learning Physiotherapy in Clinical Practice: Student Interaction in a Professional Context. Physiotherapy Theory and Practice, 25(4), 268-278.
Weerakoon, P., & O’Sullivan, V. (1998). Inappropriate Patient Sexual Behaviour in Physiotherapy Practice. Physiotherapy, 84(10), 491-499.