Day 1 of the rest of your life!

I have had a pretty hectic week in all fairness and writing this blog has become quite therapeutic to help me find time for me (which is so important whether you are qualified or student, don’t burn yourself out!).  So all of my checks have now gone through so I am now officially employed by UHB! I spoke to my manager yesterday to confirm a start date which is now MONDAY!!! Scary times. Now if that wasn’t scary enough my first rotation is on critical care!! (better get the respiratory books out!) I am very lucky because as a student I worked in the same area so at least I have some idea of where things are. One thing I will be doing is writing down some of the keys things like ABG’s, contraindications and indications for certain treatments as I know that in a new environment sometimes your mind can go completely blank so better to be prepared. I also did this as a student which was useful if I was quizzed by an educator. The things I included were:

  • blood gas values
  • Normal HR, BP, MAP values etc…
  • auscultation sounds
  • mini neuro assessment
  • contraindications for suction
  • contraindications for manual techniques
  • contraindications for manual hyperinflation
  • weaning protocols
  • decannulation protocols
  • Areas of the brain
  • Manchester Mobility Scale.

This is not an extensive list but it really helped me during placement. Alternatively you can now get mini pocket books from Flipio which has the same sort of things in a published book. See link below:

http://www.flipio.co.uk/

I am very excited to get started so I will update you on how my first day goes !!

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So last weekend I was running Seth O’Neil’s LBP: Using Sub classification to Achieve Better Patient Management course. The course gave a great insight into LBP classification which could be implemented into practice. I am going to talk about some of the stuff I took from the course . However,because it is my interpretation I will try to reference some of the main sources if you want to learn more as I think I need to go away and read around the topic myself to get a wider understanding. A great place to start would be to listen to Kieran O’Sullivan’s podcast on chronic LBP http://physioedge.com.au/pe-022-chronic-low-back-pain-with-dr-kieran-osullivan/ and the Pain Education Group website. Obviously this is not the only way to treat Lower back pain as there are many other theories but is good to attend courses so you can make an informed choice.

So as pre course reading we were given 2 papers one by Fersum et al 2012 and the other by O’Sullivan 2005. The reasoning behind classifying back pain is similar to any joint, we wouldn’t necessarily treat an OA ankle the same as an inversion sprain? So if we could why would we not classify a patient’s specific LBP problem to help direct our treatments? It is little bit more complicated than that but a good place to start is what pain mechanism is causing the patient’s pain?

So in this case we are going to look at three:

  1. Nociceptive/Mechanical Pain
  2. Peripheral Neuropathic Pain
  3. Centrally Mediated Pain

Nociceptive Pain is from activity in tissues such as muscle, joint,  skin ans viscera and can be classified by pain which is local, sharp/dull, normal aggs and eases (mechanical), predictable, antalgic pattern, absence of dysesthesias i.e. pins and needles or numbness.

Peripheral Neuropathic Pain is caused by a primary lesion or dysfunction in the peripheral nervous system. Symptoms include dysesthisa, allodynia (pain on non-painful stimulation), hyperalgesia, dermatomal pain and aggs and eases in line with neural tissue. eg. CRPS, Pain generated from the nerve. Physiology of a nerve can generate pain.

Centrally Mediated Pain is caused by a primary lesion or dysfunction in the central nervous system this can be seen from diffuse/ non anatomic areas of pain on palpation. It may be unpredictable, pain disproportionate to the nature of lesion, strong association with maladaptive psycho-social factors. e.g. fibromyalgia

A great way that Seth explains chronic pain to his patients’ is by stating:

“Firstly your pain is real!! If you can imagine doing a crossword everyday for a year- you get very good at it. This is because your brain gets bigger and creates more neurones in this area due to repetition. Therefore if your brain constantly receives pain signals your brain learns to feel pain better and becomes hard wired. So we need to think of strategies we can use to retrain your brain.”

or you can try this video how to explain pain:

There are many classification systems however this event was focused on O’Sullivan Classification (CB-CFT). Through the Fersum et al study the CB-CFT approach had far superior results compared to normal physio (MT + Exercise).

With AQP affecting MSK services in the UK it is vital we have statistics to back up our treatment effects. To begin patients should be screened using either the StartBack or Oreobro tool (these also have mobile apps).  These tools allow us to see who needs secondary intervention i.e  pain team and it also helps with prioritising  patients. One of the biggest risk factors for chronic back pain is psychological screening. One outcome measure which can be used to monitor LBP is the Oswestry Disability Index (which can be downloaded for free on if you search on Google).

The O’sullivan Classification addresses whether Back pain is:

  • Specific or non- specific
  • maladaptive or adaptive
  • movement impairments vs control behaviour

To understand this you might want to read: Diagnosis of classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Peter O’Sullivan 2005.

http://ac.els-cdn.com/S1356689X05001104/1-s2.0-S1356689X05001104-main.pdf?_tid=f8c3a4f8-2c7b-11e3-b396-00000aab0f26&acdnat=1380839851_1c7b2129e94ab33b2cc108d229937340

When assessing a patient why is it that some of us ignore passive movements of the spine whereas if we were looking at a knee joint this would not even cross our mind? So if we don’t assess passive movement of the spine how do we know whether the problem is a movement disorder so loss of movement or a control disorder full ROM but painful. It is is difficult to explain this with out providing images but please refer to the resources available.

Movement Impairment Classification- Management

  • education- regarding pain mechanism
  • reduce fear
  • CBT approach
  • restore movement impairment
  • graded movement restoration
  • graded pain exposure
  • functional restoration
  • normalise movement behaviour

Control Impairment Classification- Management

  • Education- regarding pain mechanism
  • Cognitive behavioural  motor control
  • intervention
  • pain control
  • retrain faulty postures and movements
  • self control of pain
  • functional restoration
  • normalise movement behaviour.

So at large the treatment should be direction specific, control or movement specific and should take into account psych profile.

This post is more to create awareness of the classification as I am aware I need to clarify some of my knowledge so I can further implement this approach into my practice. I think as a new graduate it is difficult to reason through some of these processes without actually getting the chance to assess patients in an MSK setting on a regular basis. One thing I will be trialing will be looking at passive movements to see how this affects my clinical reasoning in practice.

Seth was a fantastic teacher and he had great feedback from the course. Seth is one of the key Physiotherapists on twitter and his feed attracts a lot of UK and international physios so it is well worth a follow @Seth0Neill.

Some other useful resources below are:

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Comments are welcome especially if it involves discussion around Sub-classification of LBP or tweet me @LCphysio

Thank you for taking an interest.

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Grab Opportunities With Both Hands!

I just wanted to start this post by saying a massive thank you to everyone who has taken an interest in my blog. So far, I have had over 4000 views which is amazing and totally appreciated.

So this week I went to the CSP West Midlands Regional Network Study day in Worcester (Keep looking on the CSP website for the presentations under West Midlands Regional Network). I am going to discuss what I took from the event. See a few pictures below.

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When I was a student I was the student representative on the West Midlands Regional Network, which I have now passed onto Daniel Jackson (3rd Year Keele who kindly provided the photos). The West Midlands is a very active network and I have continued to have some involvement since qualifying which will be easier now I am staying in Birmingham. At the moment my role on the network is part of communications team which involves engaging members (mainly new grads with what goes on). The network are very welcoming and always like to know what is going on in your work place, so any issues can be fed back to the CSP through our chair Janet Davies or Rep to Council Philip Hulse. The study day kicked off similarly to a normal network meeting, so work place reports were discussed and key points in the CSP council papers and key messages were highlighted (For more information and minutes please go the West Midlands Regional Network http://www.csp.org.uk/nations-regions/west-midlands. The network meetings are great to find out what is happening in the real world of physio (for students)  and it is great way to share good practice or discuss work place issues for (qualified). For me the network meetings are a great opportunity to network and to find out first hand what issues are facing our profession.

I have highlighted presentations in bold so you can pick and choose which sections you read as there is quite a lot to talk about.

Presentation 1-“Professionalism in Today’s Regulatory Climate” Sue England who is the CSP Treasurer and Council Representative (@SueEngland10)

I believe slides will be put on the CSP website. I am not going to discuss everything in the presentation but this is what stuck with me: Firstly discussion of what defines your Scope of practice. Sue suggested it was a good thing to actually write down your scope each year. So what are you trained and competent to carry out? This changes with experience so it is good to know what the limits of your practice are. For me personally by writing down my scope this will highlight areas I need to focus my CPD to aid my career progression.

Secondly was the fact that as a physiotherapist you are an autonomous practitioner, this means any clinical decision you make you must be able to justify whether during assessment, clinical reasoning, treatment plan or record you are involved in. The first line of defense you have if you are pulled up by the HCPC are your notes, this mean they must be accurate, comprehensive and comprehensible ! As a full CSP member you have comprehensive public liability insurance (if you are working within your scope of practice). CSP membership is a bit like RAC/AA cover you don’t want to have to use it but that time you do the costs that would be covered would be equal to a lifetime cover so personally I think it is a small price to pay (fingers crossed I never have to face this!!)

Finally I found a good link to read  is :  http://webarchive.nationalarchives.gov.uk/20130402150350/http://ahp.dh.gov.uk/2012/02/27/voicepiece-karen-middleton-chief-health-professions-officer/ . Karen Middleton, Chief Health Professions Offcier, wants AHP’s  to be transparent following recent findings from the Francis report (although most of the findings were centred around nurses, physios need to ensure we don’t miss out on funding for leadership programs or CPD opportunities) . As physio’s we generally are not very good at challenging each others practice, so Karen’s aim is to encourage AHPs to talk about the issue of professional behaviour in a more open and constructive way, which I believe was the main message behind Sue’s presentation.

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2nd Presentation: A Personal Experience of Completing the HCPC CPD Audit- Jane Toms- Communication Lead WMRN and lecturer Coventry University.

I think one of the scariest things to think about as a qualified physiotherapist is being called up by the HCPC for CPD Audit. Each year the HCPC select 2.5 % of the profession to have their portfolio reviewed. Now lets face it physiotherapists are very good at doing CPD, however, if someone was to come and raid you’re house one evening, would it be in an organised manner? If you’re like me I have 3 folders which store everything but I wouldn’t necessarily think it was appropriate to hand into the HCPC. Jane Tom’s presentation gave a great insight into the process and revealed some relieving points.

How she completed it:

  1. Read carefully what was required: Guides,videos and examples from HCPC.
  2. Look at online resources from CSP, HCPC.
  3. Read carefully what is required again
  4. Look at the assessment criteria!!!
  5. Look at portfolio and select most appropriate CPD
  6. Keep cycling through 1-5.

Jane brought in a copy of her submission and it was quite a relief to see a very thin A4 folder!!!  So what was needed in the submission.

  • 500 words about current roles and responsibilities
  • 1500 Words on how she addressed standards 1-4 with evidence to support it.
  • Standard 5 submit it!! You do not need to use all 2000 words!

So a lot less work than you thought? However, do you write the dates of any CPD activities you do?

Standard 1: Maintain a continuous up to date, accurate record of CPD: Basically write a timetable for the last 2 years of things you have done and the nature of the activity, for example formal course, discussion, peer review.

Standard 2: Demonstrate that CPD activities are varied and relevant: so link to nature of the activities you have recorded and then link to why the activities are relevant to your current role (so link this to summary of role).

Standard 3: CPD has contributed to quality of practice and service delivery: Link evidence to a form of evaluation you can do this yourself or by external feedback you may have documented. How has CPD helped your practice.

Standard 4: Seek to ensure CPD benefits the service user. Who are your service users? Basically it could be anyone you come in to contact with so patients, students, staff etc. Try to link to service user feedback eg. cards, emails, patient feedback etc… This is probably the most difficult standard.

So what would Jane do differently next time?

  • don’t feel guilty if portfolio is chaotic
  • endeavor to be less chaotic as this would save time e.g write down CPD in diary.
  • Ask people who give positive feedback to email her- emails provide dated evidence.
  • email colleagues appreciation
  • even more collecting of positive emails, cards and feedback.

Presentation should again be uploaded onto the WMRN page.

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Presentation 3 Achieving CPD Excellence- Sophie Wickens CSP Fieldwork Officer for CPD

So following the previous presentation I think the importance of CPD has been highlighted. CPD is an ongoing process. My CPD has very much focused on how my CPD activity has affected me but I haven’t integrated it into how it has affected my service users, I have said it will but I haven’t evidenced it. A way I could demonstrate my CPD in this way could be what I learnt from working with England Cricket, followed up by documenting an email from Steve McCaig who gave me positive feedback for the work I did and how the players and coaches responded to me.

What are the benefits of demonstrating excellence in your CPD?

  • encourages further learning.
  • HCPC requirement
  • Role model to others.
  • Job satisfaction
  • Become critical about own practice.
  • Make the case to employers of the benefits of attending courses. i.e. applying for funding.
  • a way of influencing commissioners.

What resources are available to you from the CSP?

  • Pebblepad/ eportfolio proformas
  • Frontline
  • ICSP- Case discussions
  • Twitter
  • Championing CPD Scheme
  • CSP Colleagues
  • CPD Champions- reflective cards
  • QA Audit Tool
  • Physiotherapy Framework
  • CPD Syd
  • Specialist physio through professional advice service.
  • Links to specialist library
  • Network meetings
  • Annual Reps Conference
  • Clinical interest groups
  • Physiotherapy UK
  • Physio Journal
  • CSP Briefing papers
  • Website.

So there are a few things to be going on with.

Presentation 4 Top Ten Things you didn’t know about NICE Naomi McVey.

I am mainly going to bullet point some of the things I learnt from this presentation as I don’t have the slides in front of me.

  1. Maybe its just me but did you know the codes on NICE guidelines symbolise the type of paper you are looking at, for example CG- Clinical Guideline QS- Quality Standards PH- Public Health.
  2. The full NICE Guideline provides an in depth report of all the evidence and a summary whereas the web format provides recommendations. Naomi advised to go to the web format first and then follow up with the full guideline if you require more detail.
  3. NICE Quality Standards provide markers of high quality care from the best available evidence, so good to use when looking to implement a quality service.

CPD Opportunities and Resources available from NICE.

Presentation 5 Moving into the driving seat- how physiotherapy can benefit from this current climate Sue Browning CSP Dep Chief Exec.

Change in the NHS is here to stay as we cannot afford to keep doing what we are doing. There is increased competition to provide services, there is a shift to primary and integrated care to promote self-management and there is an increasing demand for quality to be monitored.

Change does bring opportunity: Commissioners are looking for more efficient and better ways of working and there is strong evidence that physio is the answer to many of the major current changes. However, we cannot assume that people know the key role of physio in preventing unnecessary admissions, providing alternative pathways and keeping people independent. Therefore it is our job to go out and take control of this agenda. Everyone has a role we need to understand and look to improve our role, sell ourselves, look for opportunities round local joint strategic needs assessments (JSNA), build support with patient groups (they will be your allies), learn from others and look to the CSP website. Tell the CSP what you need to do this? As a profession we are a team and need to work together.

Finally moving into the driving seat.

  • Physiotherapy has a strong future.
  • We all have a role in creating that future from student to qualified member.
  • Services will change.
  • Seize opportunities
  • Network, network, network and access the support.
  • Regional Networks have important roles.

So as you can see I have taken a lot from one study day I hope you may find some of it useful.

Finally what is happening with me, I recently went to help out at an extra session with West Brom using Functional movement screening to assess players. This worked in my favor as I am now going to be doing some paid work for West Brom, as one of the physios was unable to cover a day so I stepped in (It shows sometimes grasping any hint of opportunity can lead to others). I will do a follow up post for all of this as I feel I have I overloaded this post with information.

Thank you again for taking the time to read my post. Again any comments please leave on the page or tweet me @LCphsyio

Opening New Doors!

I have been really busy this week. Firstly, from finding out I have been offered a job at the QE, I have been house hunting like crazy.  I knew I wanted to live in Harborne because it was walking distance to the hospital, the area was great to meet other young professionals and with Gerard also living in Harborne, communication would also be easier regarding organisation of CPD courses.  The unfortunate thing is that because it is such a popular area, houses become available and go like hot cakes so I have struggled to even get a viewing on some. But I  have found one which is only a couple of mins walk from the high st and 15 min from the hospital which will be perfect. I will be living with a 2 girls and 1 guy which will be great to meet some new people (can’t wait to start a new adventure!!!)

So after I had been to the house viewing on Thursday night, after training with West Brom, I had to drive to Loughborough University. Through networking I had been given the opportunity to assist Steve McCaig at the England Cricket U19 Profiling camp. Steve is looking to complete his PHd on causes of throwing arm pain in cricketers. The work was expenses paid so I was provided with accommodation and food which suited me. Now baring in mind that on the Rugby camps I have been sleeping in the school dorms, I kind of expected the same for the cricket (which would have been fine for me as long as I have a bed and a shower). But I turned up on the Thursday evening about 9pm to be presented with a lovely hotel room, I was thinking by this point maybe cricket is the sport for me :-)!

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First day of the Camp I had to meet Steve at 7am at the ECB cricket centre. With Steve being an Ozzy it was difficult not to gloat about the previous ashes test but I soon recognised he completely backed the England team through and through. In the morning he quickly ran through the screening program and told me that we would only have 15 mins per player so it was going to be tight (I was thinking oh my god I hope I can keep up) . So the things we were looking at were(some were extras that needed to be covered for his data collection for his PHd pilot study): Scapula position at rest, elbow carrying angle, combined elevation, shoulder internal/external rotation, straight leg raise, hip rotation ROM, Sit and Reach and Knee to wall angle and distance. Steve wanted to know if any of the previous limitations predisposed players to certain injuries or arm pain.

The most common injuries seen in cricket are: Lower back pain, Side strain, Posterior ankle impingement, hamstring strains, lower limb tendinopathy and throwing related shoulder pain. From unpublished data Steve suggested that some of predisposing factors for injuries were.

  • Throwing arm pain- elbow : Reduced total ROM Gleno-humeral Joint and External Rotation on dominant side, reduced Combined elevation, reduced grip strength as a % of Body weight, strength shoulder internal and external rotn, back extension, calf raises.
  • General LBP: Reduced Back Extension and Side Plank times, L to R imbalance on Side plank, reduced Add Squeeze (Look up muscle slings that act on the pelvis to understand reduced adductor squeeze.)
  • LBP fast bowlers–Similar trunk muscle endurance scores but difference not as great, decreased Combined elevation, Dorsiflexion and Sit and Reach.
  • Posterior Ankle impingement: Reduced Dorsiflexion Rom and > L and R difference

So these were some of the reasons we were screening the players so we can look back in retrospective to see whether these limitations are the cause of problem and so players can be given appropriate management plans. Steve has been working in Cricket for about 9 Years so he was really knowledgeable of his sport. You become to realise that each physio at the top has their own ideas and clinical reasoning. At west brom there is a strict focus on prehabilitation, whereas England cricket would focus on physical Preparation. So I think when you get into the area you want to work in you have to ensure you make decisions about how you manage your players/ patients using your own clinical reasoning and judgement, whilst basing practice on evidence. I really enjoyed the first day of the camp because Steve took the time to explain his reasoning and provided some teaching on the Shoulder complex.

On the second day a lot of the drills in the morning were focused on batting, fielding and throwing. Each player was filmed using high speed cameras so their  technique and biomechanics could be recorded. Cricket is not necessarily a sport I follow but it was good to see a break down of skills and to see the difference between the spinners and fast bowlers. I was manning one of the cameras for the batting so I got a real close up of the players. In the afternoon most of our screening was based on muscle endurance so we were looking at Back extension, side planks, calf raises, bridges whilst the strength and conditioning coaches  also carried out other functional movement and strength tests. Again we were looking at imbalances and factors which may predispose players to injury. It was great to see that the physios and strength and conditioning coaches working closely together off the same page as I believe there is a real gap in everyday practice between health professionals and the fitness industry.

So what is in the pipe line for me now, well I am attending the CSP West Midlands Regional Network Meeting on Monday to see what is happening in the region. Regional network meetings are great for networking with qualified clinicians and most are very welcoming to students and new grads. Visit your individual region on the CSP website to see when their next meeting is.

http://www.csp.org.uk/nations-regions

After having so much backing for my blog there is a potential it will be promoted on the CSP website in the blog section so watch this space.

See some pictures below from the ECB Profiling Camp:

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Thanks for taking an interest in my blog, if you have any comments please feel free to leave them on this page or tweet me @LC_physio.

Everything happens for a Reason!

So I have now written this post 3 times because things keep changing so quickly. So just to catch up on what I have been doing the last couple of weeks (I hope I can remember everything).

Last week I attended my first training session with West Bromwich Albion, which was more of an induction to get to grips with how things were run. I was working with a physiotherapist called Mel as Nathan the main man was called out with another player in hospital. As a physiotherapist I was involved in the Prehabilitation of players during their warm up, this involved:

  • Sport specific skills including proprioception some of the exercises included were:
  • Hopping to four points with one foot, at each point volleying a football back to the feeder on inside foot, laces and knee/volley. On the return to the middle point the player had to head the ball.
  • Using a wobble cushion dribbling the ball to four cones whilst standing on one foot.
  • Jumping onto wobble boards with cushion upmost. Jumping two feet and one foot.
  • Foam Rolling, quads, hamstrings, ITB, gastroc’s

It is important to encourage injury prevention within the academy and to illustrate its importance. The activities involve challenging core stability and sports specific proprioception. I really enjoyed the session as I haven’t had the opportunity to work on prehab before and I think me and Mel were both thankful for the extra pair of hands as more players turned up than usual. Having enough physiotherapists to players is key to ensure form is correct throughout.

There is now good evidence that a prevention program consisting of a mixture of: Balance training, landing with increased flexion at the knee and hip, controlling body motions especially in deceleration and pivoting manoeuvres, can significantly reduce the number of ACL injuries. So for these players who are at the start off their careers it is vital to educate them on the use of prehab (Brukner, 2012).

http://www.peterbrukner.com/acl-injuries-preventable/

Since my induction I have been on my first proper session which was fantastic. Again the session focused around Prehab at the beginning, some of the exercises we used were:

  • Hopping on one foot onto 6 wobble cushions in a line.
  • Hopping onto on a wobble board cushion side up, jumping onto the ground same foot and then bounding a mini hurdle.
  • Using an agility ladder each player tied their legs together with an elastic band and side stepped through the ladder.
  • Hopping over hurdles in a zigzag pattern and volleying a ball back to the feeder.

We then were able to follow up certain players who needed specific rehab which was great to learn about some sport specific. Next week I will be leading on prehab with another physio and will be assisting with injury prevention screening using Functional exercise movement patterns. So I will follow up with a post on this.

With regards to job interviews I have had two recently, one for Bank work with Nottinghamshire Healthcare NHS trust and one for a private company called APOS Therapy. So first for Nottingham, I really was feeling a bit deflated about NHS interviews but I knew it was an opportunity for interview and although it was bank it covered all the rotations I wanted so I knew I had to give it everything. The night before I organised my CPD folder to match the person spec for the job (but of course they didn’t look at it…. Sods law) but anyway, I went in to the interview feeling a lot more relaxed than previous ones (I think it was because I was a bit half-hearted about it all… but it somehow calmed me down). The questions I got asked were:

  • Tell us about your biggest achievement to date?
  • How do you cope with stress? And how does it affect you personally?
  • Tell us about a time when you didn’t meet a deadline? What were the repercussions?
  • Why this trust?
  • What would you assess objectively for a patient with anterior knee pain?
  • How would you go about assessing a patient who has been admitted following a fall? What would you need to know subjectively? Objectively? And what would your management plan and goals be?

There was a few more which have slipped my mind.

From previous interviews I have realised the importance of not getting your hopes up.  On this interview I ensured I paused and composed my thoughts before speaking and I provided comprehensive answers for the two clinical questions. I got home that afternoon and looked at my phone; I had two missed calls from an unknown number followed by a voice mail. It was the therapy lead asking if I could call her back….. So of course I did and was subsequently offered the position! I was so ecstatic, the job was close to home and they were very positive with my feedback which was a real confidence boost. Of course I accepted the offer and then tried to prepare for the next interview still grinning.

Apos Therapy is a fast growing international company which focuses its treatment on correcting biomechanics by wearing some special boots. The product is fantastic and has had some great reviews see website for more information: http://apostherapy.co.uk/en/home . The interview was ok but it did demonstrate the simplicity of my knowledge for biomechanics but it was very interesting. Apos Therapy are very good at investing in people and providing intensive training but I was concerned as a new graduate that specialising to early would not help me to develop my hands on skills as a physiotherapist. So I decided that although I had got through to the second stage of interview at this time the job was not going to work for me, but if an opportunity arose at a later date it would definitely be something I would consider.

So I had decided the Nottingham job was for me and even though I had secured some bank work at Walsall healthcare. Nottingham would mean I could save some money. But then you will never guess what happened next….. Me, Gerard Greene and Tom Astley were just about to head out for drinks in Harborne (about 9pm) when I got a phone call from an unknown number. It was Janet Hallam from the QE ringing to say they could offer me a fixed term contract until the end of January, which could become more permanent if funding became available. I was in complete shock!! So I said I would call back in the morning! Of course I took the job it was the place I wanted to work for from the start and even if nothing comes of it, it is 6 months of NHS work on my CV J!!!

So although I have written this post three times due to circumstances changing, I can honestly say that everything happens for a reason! So hopefully my future blogs will now consist of my experiences as an employed graduate!! On a final note who’s to say networking won’t get you anywhere. Next weekend I will be working with England U19’s Cricket to assist with their injury prevention screening so hopefully this will open even more doors.

Thank you for taking an interest in my blog, feel free to comment or tweet me @lc_physio.

Pictures from the final Rugby Camp at Ellesmere College:

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Make your Weaknesses your Strengths!

I am writing this post following a roller coaster of a week. I feel completely emotionally and physically drained, and I even started question why I am putting myself through this. I know that is stupid I’ve only had 4 interviews (which I am completely thankful for) , but I think after 4 rejections in such a short space of time it does knock your confidence.  But as the title of the post claims you need to make your weaknesses your strengths and carry on.

Tough-Day-At-The-Office

So  I started on Monday with an interview at Derby Hospitals NHS trust. Due to me working with Worcester Warriors Community again this week, I had arranged my interview for 8.30 am so I could do both. Most people who know me, know I like to be organised and on time. I think I got a bit excited as I appeared to be waiting outside the interview room at 7.30 am (but better to be an hour early than 5 minutes late). So the Derby interview was based on a series of scenarios. There were 4 rooms, 3 scenarios and 1 personal interview , each room had 2 practitioners (I felt like I was on the apprentice and Lord Sugar was going to come out and say your fired or hired!!).

The first room I was in was the personal interview which I was thankful for to break the ice. Some of the questions I got asked were:

  • Tell us about you?
  • What do you think about customer service?
  • Tell us about a situation where you have had to motivate a team?
  • How do you deal with stress?

There was a few more questions but I can’t remember them all. From my previous interview at the QE I felt I shut off and needed some prompts to keep speaking (I think the nerves probably got the better of me). So on this interview I tried to keep speaking until they shut me up.

The second room was a respiratory case study (resp and neuro tend to be my weaker areas mainly because I have had less experience in them) but I felt I was able to work through the case study fairly. There were things when I came out that I could have included but I suppose when your under pressure some things don’t always come to the front of your mind.

The third was MSK, which if do say so myself I blasted. Typical presentation of a frozen shoulder but with a past medical history of a mastectomy (which can have an impact on the shoulder due to radio/chemotherapy sometimes causing tightness) so they wanted some discussion around this.

Finally was a neuro case study. They wanted to know what you know about stroke? What your goals for discharge would be? What would you do if a patient was being discharged by a doctor but you weren’t happy? Again there were some others but I can’t remember the rest.

So overall I felt a lot more comfortable in this interview but I sometimes felt I deviated from the point in the personal interview. So we were due to hear feedback on the Wednesday but I didn’t hear anything. One of my friends had already received an email to say that unfortunately they had been unsuccessful, so due to not hearing anything I thought I would be in with a chance…..But no phone call…..I rang the trust today to find out the decision but unfortunately I had been unsuccessful.  I think I had got my hopes up as I had felt comfortable in the interview and due to others receiving emails… but they just hadn’t sent mine. So as you can imagine I was pretty gutted. The feedback I got was that sometimes I was not concise in my answers for the personal section (which at the QE I was too concise and closed) so I need to find a happy medium. The only other point they made was that I could have been more evaluative in my respiratory case study (which I suppose comes with experience). They were positive in saying I was employable (BUT THEY DIDN’T EMPLOY ME GAHHHH HAHA) but unfortunately they said it was very competitive. On the other hand I did get the offer of bank work off the back of it so fingers crossed that might lead to something else (fingers and toes crossed).

I have another interview for Nottingham CIC bank 4th September so I can let you all know how that goes (I think soon I will have had an interview at every trust it feels…. so I will be the guru of interview questions).

From my previous post, I had discussed my interview at the QE, which I received feedback for on Monday. I scored 23/51 on the question paper again did well on MSK (but lacked some detail, for example I might have said ROM exercises but not specified which ones) and to my surprise respiratory was OK but I wasn’t detailed enough in the orthopaedic question.  They said I came across well in the personal interview but just missed some of the buzz words and sometimes required some prompts (more nerves than not having enough to say). But again I am on reserve list for 3 months so hopefully something might come up.

So for my next interview things I will be working on:

  • Preparing points for generic interview questions so I can be more concise.
  • Ensuring my CPD folder is linked to the post.
  • Learn to relax!!!
  • Finally work through some more respiratory and neuro case studies.

Like I said above I have been back at the Worcester Warriors this week, but working with under 12’s. It is fair to say under 12’s are a lot more demanding, not necessarily in relation to injuries but more in relation to their behavior, but we have great staff at the camps and  everything got done in the end. I am back at the camps again next week for a final week so I will update you then. Tomorrow I will be up very early to head over to West Bromwich Albion Football Club for an induction, so I am looking forward to that (but maybe not the early start after this week). But again you have to embrace opportunities that come your way.

Thank you again for taking the time to read my blog. If you have any questions feel free to comment or tweet me @LCphysio !

Welcome to the real world!

So continuing my journey I am writing this post following a very busy week in the real world of physiotherapy. This week I have been working at one of the Worcester Warriors senior training camps (12-17) as their physiotherapist. It is fair to say that looking after 87 children is quite a feat and I apologise in advance for any spelling or grammar errors as my brain feels like mush. I was employed to work at the camp through the Markland clinic which is based in Swindon and Cirencester (http://www.marklandclinic.com/). The team at Markland have been a great help this week providing me with a fully kitted out pitch side bag (not many work places would do this) and a nice water proof jacket (which definitely came in handy). So I plan to exchange some of my experience of the camp to give you an idea of what I came up against.

The first day I was met with one of the Markland team called Mike who was there to give me the ins and outs of what I would be doing and introduced me to the team. I must say after working with the Rugby League team at University, which at a push had a max of 20 players playing a game, going to 87 kids was a bit daunting :-S ! But on the first day Mike stayed around and we had a manageable caseload between the two of us. The camp was at Malvern college so we all stayed in school accommodation and were very well catered for in the food department (Definitely need a permanent job to get myself  back into the routine of going to the gym after this week.).

Our normal day would start with an optional fitness session at 7am and finish at 10 pm although when in demand you can be called out at anytime for example when some of the kids get food poisoning at 4am… So long days but as a physio we weren’t required the whole time so we did get chance to have some wind down time. I was joined on the 2nd day by another physiotherapist called Charli Robertson at first I had been told by Mike that Charli was a student physio. I was thinking oh great that is all I need 87 kids and a student physio to look after now I will definitely be out of my depth. Luckily for me there was a mix up and Charli was also fully qualified and was studying for her MSc in Sports Medicine. I would say a very good person to have around!! Our job as the physio was to assess and treat anything that came our way from blisters to head injuries. I found the whole process a great learning curve, I have never had the opportunity to work with children except for the odd MSK outpatient referral so there was a lot of sussing out the real cause of problem. For example some kids would come saying they have leg pain yet could not pin point the exact point and everything would be painful however, most of the time with some magic spray the problem miraculously vanished ;)! I really did rely on my communication skills to adapt to the different age groups to be able to perform accurate assessments and treatments. (Though most of the time I just suggested we chopped their limb off which they weren’t too keen on.) On the flip side of presenting complaints some players would play down a problem and would not tell us until a few days later mainly I think because they did not want to be seen as weak to others or to not be seen by the coaches who were potential scouts. For example we had a fractured radial head which wasn’t investigated until 3 days after the incident, but after educating them all about the importance of telling us if there was a problem we had an influx of cases, which resembled a very busy A+E at some points of the camp.

So the main things I have taken away from this camp that I will implement into my future practice:

  • The importance of  adapting my communication with players, staff and parents.
  • I have revisited assessment, treatment and taping techniques.
  • I have established the importance of communication within the team. Making sure you can speak with the coaches can give you valuable information about the incident you are dealing with.
  • The importance of not underestimating or overestimating an injury. If something doesn’t seem quite right it is important to get a second opinion.
  • The importance of knowing your own scope of practice (As a newly qualified unfortunately I don’t know everything and sometimes just need a little reminder to bring some previous knowledge back to me, if you don’t use it you lose it.)
  • Finally it has got me back into writing clinical notes (which was so strange as no one was signing them)

So I have had an eventful few days but I have loved every minute of it as I am finally using my degree to do the job I have loved studying for the last 3 years.

Some of the benefits I received whilst doing this job:

  • I got to work with 2 great teams. (Worcester Warriors and the Markland Clinic)
  • I was able to go and watch a Worcester Warriors Match.
  • I received some free Worcester Warriors clothing (everyone loves a free t’shirt)
  • Contacts for future opportunities.
  • Finally complete job satisfaction with parents, players and staff ending the camp in high spirits.

For the next 2 weeks I will be covering another 2 camps which will be great. Next week will be a junior camp so (9-12) and the second will be a split camp 2 days junior and 2 days senior, so I will let you know if I have any interesting stories for you.

Below are some pictures from the camp:

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So back to the real world in the NHS I have had a reply form Birmingham University Hospitals NHS Trust. Unfortunately this time I have been unsuccessful however, I will be on the reserve list if another post becomes available within the next 3 months so that is promising so I will keep my fingers and toes crossed :-)! Below are some of the questions I got asked in the interview (I can’t remember all of them):

15 min question paper

You have a 22 year old man who has been in an RTC and has a fractured femur and has had a dynamic hip screw to resolve this.

a)      Goals 1st day post op?

b)      Goals for discharge?

c)       2 days post admission the patient has been found to have a fractured clavicle, how does this affect your management?

You have a 28 bed ward and your band 7 has phoned in sick, you have the assistance of a band 3 assistant, what do you do?

What are the signs and symptoms of a contracted shoulder? What would your management and advice be?

What would your assessment be of a patient with Type 2 respiratory failure?

What is the difference between type 1 and type 2 respiratory failure?

What conditions would present with type 1 and type 2 respiratory failures?

Interview panel

Why this trust?

Why do you want to be a physio?

Tell us about your placements? Identify your weaknesses and learning needs.

How do you cope with stress?

How have you demonstrated you match the trusts visions and values?

Have you been involved in service improvement? How have you done this?

What would you do if a patients’ relative made a complaint that you weren’t giving them enough physio and that they had been told they would be seen 3 times a day? The patient also has dementia.

What defines a quality service? How can this be measured?

I really love the QE and I had a great placement on ITU and even when I went on an informal visit before my interview I was still shocked at how many different areas there were in the hospital that I wasn’t even aware of. I am still awaiting feedback from both Nottingham and Birmingham but when I receive it I will let you all know what I could have done differently and how this will change how I will prepare for future interviews . In the mean time before I start work on Monday I have another interview at Derby Hospitals NHS Trust at 8.30 am :-S (I am going to be the walking dead by the end of the week) and I have also applied for a bank job with Nottingham CIC Bank.

So I have plenty of stuff to fill you in with in the next couple of weeks, maybe I should say to the interviewer when they ask me why do I want to work their trust that I am fed up of writing my blog about interviews I didn’t get ;-)!

Again any comments are welcome or you can tweet me @LCphysio x

Time to Reflect!

So I am feeling in a reflective mood following a hectic week  (I have to apologise to my boyfriend as he told me to reflect a bit to early on when everything was a bit raw and I wasn’t very grateful for his advice, but I have come round). When I last posted I had one interview at Birmingham. Since then I have received 3 more! At Nottingham, Derbyshire Community and Derby Hospitals NHS Trust.  This week I have had one at Nottingham, one at Birmingham  and a telephone interview with Derbyshire community. Fair to say it has been quite stressful and I feel physically and emotionally exhausted. I am going to talk about my Nottingham and Derbyshire community interviews as those are the ones I have heard back from which unfortunately have been unsuccessful, but like the title of the blog is it’s time to reflect.

So I had my Nottingham interview on the Monday, luckily for me my mum volunteered to drive me so I could chill out and focus on the interview. With the interview being in the afternoon I had spent all morning pacing up and down so I had kinda wished my interview had been in the morning to get it over and done with. When I got there I had to go straight to HR to give in documents which was a fair distance to walk and not very easy to find so I was glad I gave myself plenty of time, though I was so flustered when I finally got back to the reception to wait for my interview.

So the interview came around, I had two female interviewers who were both very pleasant and took it in turns to ask questions. The questions I can remember were:

  • Why did you want to work for the trust?
  • What attributes would you bring to the post as a band 5?
  • How would you differentiate between acute hamstring and sciatica? Treat one of them.
  • You have a patient who has a left sided infarct. What would you expect to find on assessment and what would you tell your colleagues to help them if they were going to be treating them?
  • What are your learning needs to be able to go out on respiratory on call?
  • Questions on trusts values and behaviours.
  • You have a patient who has dementia the team is happy for him to go home but you have concerns how would you deal with it?
  • How would you show a patient they were cared for?
  • What would you do if your senior wasn’t using the proper hand washing technique?
  • You are on an orthopaedic ward with 28 beds. What would you do if you were the only qualified member of staff because your senior is off sick?

I’m sure there were more but these are the ones I can remember. I am yet to receive feedback as I have to wait 2 weeks, but on reflection one of the big questions I messed up on was the orthopaedic ward one! (which I will be gutted about if that was the only thing I didn’t do right as I have been having nightmares about it). Basically I answered it by talking about getting handover, having a team meeting to see who could help out and then work from there. If I had my brain switched on I would have talked about the importance of prioritising patients and delegating to the physio assistant which I didn’t gahhhhhhh!!!!!!!!

Another question I could have gone into more detail about was my learning needs to go on call. Not only do I need more experience in dealing with respiratory patients along with the mandatory training. But I also could have talked about being trained on equipment such as mechanical ventilation etc. Hind sight is a great thing!!! There maybe more things I could have done but I will await feedback and will post as soon as I do.

This Thursday I had 2 interviews. I had Birmingham in the morning and a telephone interview in the afternoon as part of a short listing process for the community post. Like I said before I will talk more about the Birmingham interview when I get feedback not holding out too much as there was only 1 post available and 8 candidates were internal!!! Urggh physio is sooo competitive. So for my telephone interview I was asked 4 questions. This job would have been ideal as it is 5 minutes from my house but anyway. All candidates were asked the same questions the first 3 I coped with fine and the interviewer didn’t have any comments to make on them and because they were OK I can’t for the life of me remember them. I think there were:

What makes a good band 5 physiotherapist in the community?

How would you go about maintaining safety in the community?

I can’t remember the 3rd one!

But the 4th one I remember clear as day because I completely fluffed it!!! I was asked to talk about a neurological patient I had seen and to talk about there management and treatment. Now this sounds a straight forward question and it would have been if I had been asked it again but at the time I was so drained from my previous interview that my brain yet again failed me. My pure neuro placement had been my first 2nd year one and I felt I would have been to vague with my answer to discuss one of my patients because it was such a long time ago so I decided to go with one of my patients I had seen on my second to last placement (who actually really wasn’t a true neurological patient so I really shot myself in the foot). This was the question that prevented me getting shortlisted and if I was asked the same question again I would have answered it completely differently. I would have talked about one of my stroke patients, the patient’s symptoms, physio treatment, outcome measures, and MDT involvement but my brain wasn’t quick enough to process the question.

So all in all I was pretty gutted about the Nottingham post as it looked a great hospital to work at, but a better physio was found on the day. I still have the QE to hold out for which is my number one place to work but after hearing there is only one position I am starting to doubt myself :(!

So anyway lets end on a positive so apart from interviews today I have had the opportunity to attend a meeting with West Bromwich Albion Football club with Head Academy Physiotherapist Simon Noad. My role with the club will be on a voluntary basis and will involve assisting the part time physiotherapists with any of the U16 players… a foot in the door you might say. I am really grateful to Gerard Greene for passing on my CV to Simon and I look forward to telling you about my experiences.

So although I am not telling you how happy I am about securing a job I am back on a positive mind set after writing this piece and I am just taking that those jobs were not meant for me. I start the camps with Worcester Warriors next week so watch this space 🙂 !! Again if anyone has any comments please post them on here or tweet me at @LCphysio xx