Meeting to get re instated after failing clinical

[Agent007]

I am seeking any advice at all.
I had my first clinical at acute care hospital and just got dismissed after 5 weeks ( my timeline was 8 weeks instead of 12 weeks due to pandemic). I was completely overwhelmed by the setting and most of my patients had cognitive deficits, which was very hard for me to get through. I made simple mistakes over and over due to stress and severe performance anxiety.
They told me i have failed and therefore am dismissed from the program and I can appeal. I filled out appeal form and next will be meeting with committee. I don't know whos going to be at that meeting and if
Its going to be more like explain yourself format or more of attack me w questions mode. I am completely petrified and looking for anyone with any experience, kind words or advice.
I am trying to hold myself together and not spiral down into the deep dark places.
I feel like i was put into disadvantage with hardest rotation of them all, while some of my classmates are sitting home and doing telehealth.
I ll take any words of wisdom or advice or support right now. Thank you...

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[wiseOldPT]

Try to take emotion and blame out of it as much as possible. You want to come across as composed and articulate, able to clearly communicate. Is this a clinical at the end of your program (are you done with all the courses) or do you still have more courses to go? That changes expectations.

Talk about your track record in your courses. How have you done on practicals? If you can demonstrate that you did really awesome in classes and had positive feedback, especially with the areas identified as weaknesses, that will help make your case. Were expectations for the clinical clearly laid out? How did they give feedback? Did you have chances to improve on specific areas? The "best" case would probably be 1) you've been an excellent student in both didactic and more practical skills courses; 2) You were put into a clinical you were not prepared for, with unclear expectations, and did not receive the feedback/instruction necessary for your learning. How did the feedback you get contribute to your performance anxiety? Don't launch into a "this was hard and others had it easy" but focus on how you were not set up with the proper supports for success (if true) and what you would need to be successful in the future. Be humble, but do advocate for yourself.

This is shockingly common. PT clinical education needs a total overhaul in my opinion. If a student really has the deficiencies that would make them fail a clinical, this should be figured out far ahead of time. Many clinical instructors are poor educators, and decide the fate of students. Hope it might help to hear you aren't the first to have these challenges.

 

[kdubz7w7]

I am seeking any advice at all.
I had my first clinical at acute care hospital and just got dismissed after 5 weeks ( my timeline was 8 weeks instead of 12 weeks due to pandemic). I was completely overwhelmed by the setting and most of my patients had cognitive deficits, which was very hard for me to get through. I made simple mistakes over and over due to stress and severe performance anxiety.
They told me i have failed and therefore am dismissed from the program and I can appeal. I filled out appeal form and next will be meeting with committee. I don't know whos going to be at that meeting and if
Its going to be more like explain yourself format or more of attack me w questions mode. I am completely petrified and looking for anyone with any experience, kind words or advice.
I am trying to hold myself together and not spiral down into the deep dark places.
I feel like i was put into disadvantage with hardest rotation of them all, while some of my classmates are sitting home and doing telehealth.
I ll take any words of wisdom or advice or support right now. Thank you...

Hi there,
- Did your CI give you feedback right away that your performance was unacceptable? Did they help you try to improve? Or did they just say at week 5 sorry you have to go? What did you do to try to improve your performance? Do you agree with your CI's assessment of your performance? Depending on how this went, you'd have a lot of ammunition to arm yourself with.

- Did you feel your CI was fair overall? Are you done with didactic or do you have more courses to take, and did your CI have a clear understanding of where you are in your education? In other words, did your CI have unfair expectations? For example, my first rotation was IP in a neuro hospital, and I still had 4 more didactic semesters after the rotation. So, my CI knew I didn't know anything about cardio, neuro dx's, integ, p&o, etc, all the information I had yet to learn, and therefore did not expect me to know as much as, say, a final rotation student, and I passed just fine.

- Did you do anything to manage your stress and anxiety? I'm just thinking at this meeting, if you use that as a defense, they are going to ask you this question.

- I would not say anything about having "the hardest rotation of them all". Plenty of students do acute care as their first rotation and pass, and different students perceive different things as difficult anyway. Telehealth could be made to be more challenging if the CI asked the student a lot of challenging questions, or it may be that student's weak spot, for example. I am not trying to be a jerk here, I am just saying....don't go there, it won't be looked at favorably. They wouldn't have sent you there if they felt you weren't ready in your education.

I know there is a lot I don't know, but from what you have said, I feel like your best defense would be somewhere around a miscommunication of expectations with your CI if one existed (and I feel like there must have been unless you were just completely unable to pull yourself together).

Side note, my clin ed director told us that SHE and our school makes the final decision about us passing, not our CIs. She thinks it is completely unfair and unreasonable to have our entire futures held in the hands of one person. I know that doesn't help you but like someone else said, the whole system is just kind of wild. So as someone else advised, how is your academic record? Is it at odds with this clinical grading? That might be something else to speak to, if you have good grades and tend to perform well on practicals.

I'm just a third year student, not a PT or CI, this is just me thinking out loud about how I would approach this. Good luck!!

 

[Agent007]

Try to take emotion and blame out of it as much as possible. You want to come across as composed and articulate, able to clearly communicate. Is this a clinical at the end of your program (are you done with all the courses) or do you still have more courses to go? That changes expectations.

Talk about your track record in your courses. How have you done on practicals? If you can demonstrate that you did really awesome in classes and had positive feedback, especially with the areas identified as weaknesses, that will help make your case. Were expectations for the clinical clearly laid out? How did they give feedback? Did you have chances to improve on specific areas? The "best" case would probably be 1) you've been an excellent student in both didactic and more practical skills courses; 2) You were put into a clinical you were not prepared for, with unclear expectations, and did not receive the feedback/instruction necessary for your learning. How did the feedback you get contribute to your performance anxiety? Don't launch into a "this was hard and others had it easy" but focus on how you were not set up with the proper supports for success (if true) and what you would need to be successful in the future. Be humble, but do advocate for yourself.

This is shockingly common. PT clinical education needs a total overhaul in my opinion. If a student really has the deficiencies that would make them fail a clinical, this should be figured out far ahead of time. Many clinical instructors are poor educators, and decide the fate of students. Hope it might help to hear you aren't the first to have these challenges.

I have done good on my msk practicals and not so good on my in patient practicals. Didacticly i was just ok, so that would be held against me too?
I was just really was completely overwhelmed by the hospital and did not know that CI is gonna report every single detail up the chain. Also she didn't communicate to me that I was doing completely terrible. When she was correcting me i thought it is a part of learning process and than my advisor told me she told her that she repeats stuff and i am not getting it. I just feel like first we were locked up fir corona and than i was thrown into this situation. I honestly didn't realize how harshly the mistakes will be assessed. I never ever seen or worked with pts with cognitive issues and was having very terrible experience, not being able to think on the spot.
I had to strategy to control anxiety either. Is that something I should never admit to?

 

[Agent007]

Hi there,
- Did your CI give you feedback right away that your performance was unacceptable? Did they help you try to improve? Or did they just say at week 5 sorry you have to go? What did you do to try to improve your performance? Do you agree with your CI's assessment of your performance? Depending on how this went, you'd have a lot of ammunition to arm yourself with.

- Did you feel your CI was fair overall? Are you done with didactic or do you have more courses to take, and did your CI have a clear understanding of where you are in your education? In other words, did your CI have unfair expectations? For example, my first rotation was IP in a neuro hospital, and I still had 4 more didactic semesters after the rotation. So, my CI knew I didn't know anything about cardio, neuro dx's, integ, p&o, etc, all the information I had yet to learn, and therefore did not expect me to know as much as, say, a final rotation student, and I passed just fine.

- Did you do anything to manage your stress and anxiety? I'm just thinking at this meeting, if you use that as a defense, they are going to ask you this question.

- I would not say anything about having "the hardest rotation of them all". Plenty of students do acute care as their first rotation and pass, and different students perceive different things as difficult anyway. Telehealth could be made to be more challenging if the CI asked the student a lot of challenging questions, or it may be that student's weak spot, for example. I am not trying to be a jerk here, I am just saying....don't go there, it won't be looked at favorably. They wouldn't have sent you there if they felt you weren't ready in your education.

I know there is a lot I don't know, but from what you have said, I feel like your best defense would be somewhere around a miscommunication of expectations with your CI if one existed (and I feel like there must have been unless you were just completely unable to pull yourself together).

Side note, my clin ed director told us that SHE and our school makes the final decision about us passing, not our CIs. She thinks it is completely unfair and unreasonable to have our entire futures held in the hands of one person. I know that doesn't help you but like someone else said, the whole system is just kind of wild. So as someone else advised, how is your academic record? Is it at odds with this clinical grading? That might be something else to speak to, if you have good grades and tend to perform well on practicals.

I'm just a third year student, not a PT or CI, this is just me thinking out loud about how I would approach this. Good luck!!

Hey thanks for reply! I have 1 more didactic semester, but its mostly just research and some electives. And my grades were never stellar, the problem was being completely overwhelmed by patient population. A lot of it was my fault of not thinking on the spot and some of it was me not knowing the expectations and not knowing that while my CI was nice to me, she reported everything up the chain. I didn't even know i m going to the clinic till the week before cause they told me everything was cancelled. The whole thing was a mess w Corona and than out of nowhere i m wearing all this ppe equipment in the hospital. I was still in pandemic mode, not mentally ready for the clinical, which is my fault in a way. But kicking someone out in current circumstances? It was poor performance, but i didn't harm anyone.

 

[kdubz7w7]

Hey thanks for reply! I have 1 more didactic semester, but its mostly just research and some electives. And my grades were never stellar, the problem was being completely overwhelmed by patient population. A lot of it was my fault of not thinking on the spot and some of it was me not knowing the expectations and not knowing that while my CI was nice to me, she reported everything up the chain. I didn't even know i m going to the clinic till the week before cause they told me everything was cancelled. The whole thing was a mess w Corona and than out of nowhere i m wearing all this ppe equipment in the hospital. I was still in pandemic mode, not mentally ready for the clinical, which is my fault in a way. But kicking someone out in current circumstances? It was poor performance, but i didn't harm anyone.

You didn't know the expectations of clinic? We had to do a training to understand the roles of student/CI and how we are assessed in all different domains, I thought that was standard for all DPT students. Also, I've done 3 rotations and each one, the CI sat down with me and we discussed together expectations. None of that happened for you? Because that is definitely a problem.

What difference does it make that she was reporting everything to upper management? Just wondering. You have to understand that patient safety & privacy are paramount, and anything you do or don't do is happening under her name and license, so she has her own share of CYA to do, if she felt it was necessary.

What sort of mistakes were you making? You've said you made a lot, poor performance etc....so was it, say, documentation errors, or patient-handling errors? There is a big difference in mistakes that do or don't potentially harm patients. And did she indeed correct you over and over on the same thing/s? Can you speak to why she had to repeat herself so much? I'm not asking you, I just think it is something to address at your meeting. Was she a bad teacher, did you have poor communication with her, did you not understand what she wanted.....

I don't see how the virus really changes anything, speaking as someone in a similar boat. We also got kicked out of rotations, sat around at home, and some of us got called back into clinics who were willing to take us and are doing fine.

Maybe a better question is, how can you explain and defend what happened, so that your school understands this wasn't your fault, won't happen again, and you know what steps to take now to avoid this ever happening again? Do you have a trusted advisor or faculty member that you can talk this over with, so they can help better guide you? I feel like someone who knows the specifics can help you better.

 

[wiseOldPT]

I'd be concerned that this is looking like a record of struggling in some areas of classes/practicals and now struggling on a clinical. Why do you think you shouldn't be dismissed? Maybe coming at it from that angle would help make your case. What would you need to be successful? This doesn't mean "easier clinical, no pandemic, different setting" but things like "I need written feedback daily instead of verbal feedback weekly" or "I need to review skills X, Y and Z with my faculty before I'm ready." Actionable things that would show that you are addressing your deficiencies and guarenteed for success if allowed back.

 

[ya1]

Here is another important question: were you under direct supervision by your CI 100% of the time? If the answer is NO, definitely use it in your defense. CI must be by your side 100% of the time and guide you through your clinicals 100% of the time. CI should be able to prevent your mistakes or not allow them to skyrocket. If a CI sees you are making a mistake, s/he should discuss it with you in private and guide you how to correct the mistake and not to make it again.
What are the "simple mistakes" you were doing over and over again?
You also should be able to tell your CI that you do not feel comfortable doing this or that YET. In your defense, you may say that you were too afraid to tell your CI you are not ready to do THIS AND THAT which led to your mistakes. You have learned that you should be able to communicate your fears with your CI to avoid those mistakes and you will do your best to be a better communicator in the future.
Not being able to think on a spot is very normal for many beginners! Not everyone's brain is capable of processing information fast. There are fast thinkers and slow thinkers. If you are a slow thinker, that is ok and you are still able to be successful in PT. You will just need to choose the setting you are working in wisely. For example, now you may know that an acute hospital and a fast-pace environment is not a good fit for you. An outpatient ortho where you will have to see more than 1-2 people an hour will probably not be a good fit for you either. Now there are settings where you treat patients one-on-one and do have time to think. Some examples: neuro setting (working with people with SCI or CVA), vestibular disorders, edema management, working with amputees, even SNF or ALF... Tell the committee that your recent negative experience also had positive outcomes (see above regarding your choice of work setting) and it is good that you found it out during clinicals and not after graduation. Clinicals are for you understanding better what is a good fit and what is a bad fit for you.