Today I had two new patients in the afternoon and both case histories went very well. I was pleased with myself how I managed them and I especially as I had time to both treat them at the first appointment!!!?
When I cam back to the team point my tutor gave me a very positive and encouraging feedback... He raised that I have improved massively in my communication skills when dealing with patients. That makes me so happy!!
I asked him to provide me his feedback written so that I can add it to my blog.
| feedback_for_communication_improvement.pdf |
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Today we had a tutorial in clinic on general feedback from our first CCA. There were common mistakes and issues that came up between students. To avoid those for the next CCA and future practice we all agreed that it would be great to get a tutorial on those points.
The suggestions want to list here are not in any order,...
We were told that we often ask our patients to relax so that we can perform for instance a passive examination. However in doing so we jiggle the patient's limb and this would not facilitate any relaxation. Especially as our patients are in discomfort and seeking for help from us. For the future it is important to work on this as engaged surrounding tissue can provide false negative findings on passive assessments.
The next point that was risen was that we need to be sure with our working diagnosis for our returning patient, especially as we have seen them before for treatments. Also are we required to know all diseases they also suffer from and their pathology possibly having an influence on the current symptoms.
When taking a new case history 'listen to' was the patient is saying. Often we tend to repeat things that patients already expressed. Additionally is it advised not to ask 'leading' questions like 'do you?'. Patients are likely to answer with yes or no to give a favor rather than proving them with details. However there are cases when 'leading' and 'closed' questions are very helpful and in the situation of a CCA we are advised to tell our examiner why we have used this questioning style. When patients find it hard to express themselves these questions are very helpful. However a balance not to take over the whole discussion is beneficial.
We should only consider diseases/illnesses if our patient complaints of all the typical signs and symptoms (text book presentation) rather then guessing they could have ....
If we consider any pathologies or referrals from for instance viscera a GP referral will bring further clearance. Then we are sure and no longer work on suspicion.
We were also advised this morning not to say 'I ruled out' as we are not able to rule out just only from palpation there and there will always be clinical uncertainty we are dealing with. Another phrase we should avoid is 'its not a disc because there are no neurological symptoms'. It is necessary to provide further details why we are not considering a disc being the cause for a patients discomfort. Therefore details about the onset, progression, and nature of pain would be useful to explain during the CCA presentation process. Only on disc prolapse and herniation we would definetly get neurological symptoms, however chemical irritation, annular strains and discal tears could also give neurological symptoms-which make it even harder to distinguish the cause!!!
Considering questions on accidents and injuries it would be relevant to ask more in depth if they seemed to be relevant to the case. considering road traffic accidents (RTAs) it would be good to know the speed during the collision and direction of impact.
One other point was raised before be finished this tutorial was that when a patient complains of pain/discomfort in the posterior thigh on the straight leg raise test (SLR) this should not be considered as a postive test. There are other likely causes for this discomfort that need to be explored.
This was a really helpful precise tutorial. I will come back to those raised point so that I can avoid those during my next CCA and future practice.
Im in Christmas clinic this week and as fourth years are together with third year students I had the change to observe a case history process a third year was taking. On this patient I observed a neuro-assessment was required. I had learned all the interpretations and meanings before but it was good to go over this again with the tutor after we saw the patient. Joint position sense travels through the dorsal column and Pin prick tests for the spinothalamic tract. With pin prick tests it is necessary that the patient feels it as a pin rather then just tough. Light touch assessment would not be clinical relevant as it travels through both pathways and therefore does not allow to make a specific statement. This was a great change to recap my knowledge on the relevance of neuro assessment tests!
Today I got both my feedback for my CCA and for this term's general clinic. I had prepared myself for this feedback session when I noted on a self-assessment sheet my strength and weaknesses for this term. My tutors were very pleased with my work this term and I got very good comments:
''A good solid term's work - we have no worries and are sure you will continue to improve as your confidence grows with increased experience.''
''Karolin is an extremely thorough and diligent student. She has an excellent knowledge base and works hard to maintain her standard. Her tutorials have been excellent...''
Using both my self assessment sheet and the tutors' feedback we agreed that I need to improve my clinical performance, justification of findings, confidence in diagnosis making, presentation skills but also my English language skills regards communication and conversational skills. To work on this areas we agreed to an action plan that I would like to practice the CCA process on a regular basis,.. therefore it would be great if tutors replicate the exam situation when I take new patients. I will also try to get some time before I present my hypotheses to write likely differentials on a sheet of spare paper with justifications.. this will help me to have a flow in presenting a patient. As I struggle to present in a clear, precise and fluent manner.
Considering my CCA feedback I am suggested to change my order when taking a case history e.g. to allow the patient to share their current symptoms first before questioning on lifestyle, profession etc. By now we were taught the other way round however I will give this a go as it makes sense to me to listen to the patients complaint first before bothering with probable unrelevant details which could possibly bias my thought process.
I also was recommended to work on my empathy and communication skills. I have noticed this a couple of time especially in Manna during the last weeks and started already to work on this.
I am very pleased with my feedback and look forward to next term!!!
| student_self_assessment_k.krell.doc |
| File Size: | 16 kb |
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Tonight I got the email that I passed my CCA last week!! Such a relieve, can't wait to get the detailed feedback next week...
Two weeks ago I gave a tutorial in clinic on foot differentials. I welcomed this as it was a change to work on my presentation and communication skills. To make this a good learning experience I asked my audience for some feedback therefore I send them an email with the link to a survey monkey questionnaire, using the in-house mailing system, after I had given my presentation.
Clinic tutorial feedback
My audience, which included third and fourth year students, rated both the tutorial (71,4%) and the power point presentation (100%) as 'useful'. The majority would like to receive a handout. Also did the audience rated me as having 'a good understanding of the subject'. 57,1% experienced the 'short foot posture exercise' as 'useful', while 71,4% noticed when doing this exercise the importance of feet on our balance, body posture and proprioception. As this were excercise I use with physiotherapy patients I had asked if my osteopath colleagues would like to learn more about those techniques I had learned during my previous studies. 71,4% would be happy to learn more while 28,6% are not sure if they want to get to know more physiotherapy intervention. I also provided an open section in my questionnaire to leave my colleagues the option to provide further feedback. In this section I got the feedback that 'my voice sometimes went really low so it was difficult to understand..'
I really appreciate this feedback and will use this frame of gathering details in the future especially as preparation for my dissertation presentation but also CCA patient presentation skills.
| surveysummary_foot_tutorial.pdf |
| File Size: | 101 kb |
| File Type: | pdf |
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Today I had my mock CCA which will be similar to the final CCAs in spring term. This time I had only one continuation patient that I had seen before and one new patient while in the real CCA I will have two new patients in a row. So it was a great experience. We had two assessors and one operator per student. It was a completely different scenario as I had never presented to these tutors. On normal clinic days were are always having a dialog with our tutors and can ask for their opinion however today it was all our responsibility and decision for what we do. My first patient was my self chosen continuation patient which went pretty well. I was asked a couple of questions whilst treating but think I managed the situation quite well. Sometimes I got very distracted that three extra people went in and out of the room... also quized by question from an unfamiliar examiner was quite a challenge. Having made this experience I plan to practice this with my study group. The idea I have in mind is that we will role play case histories, case presentation but also whilst practising technique to quiz each each other on decisions but also unrelated questions to an area we e.g. practice on in this moment. I also had to write a precise report for my continuation patient which was a great experience as we normally do not have to do this. The aim was to summaries the patients presentation, my management and progress of my treatment by today. I find this a useful step in presenting a patient to other colleagues and could also use this when I discuss patients with my colleagues as this could become helpful when I am qualified. then I am familiar with the process of writing reports not only to osteopaths but also other health care practitioners.
I had my new patient straight after and think it went quite well as well. I am very pleased with myself. However I need to work on my time management as I hardly had time in the end for treatment. This time it was required to present in a very clear and structured way my findings and use these to back up my clinical diagnosis. We have practiced this the whole term however in a CCA situation it is so different, no help, no hints,... and the decision needs to be made promptly.
All in all, I am very grateful that we have the change to have such a mock CCA, great experience! ....now I eagerly wait for my feedback!!!
Today I gave a tutorial for my team on foot and ankle differentials. I had prepared a power point presentation and went through the most common presentations but also added some uncommon conditions which I came across during my preparation. My colleagues were very grateful that I went through the differentails again as this is a good preparation for the CCAs. In the end I decided to finish off with an active part and therefore asked everybody to wear off their shoes and socks. I tried to demonstrated how important the foot and ankle complex is and that we should not miss to consider this when we assess and treat our patients. I briefly went through the physiology of the 'short foot posture' from Janda, a czech neurologist. I myself had learned this during my physiotherapy course and wanted to share this with my osteopath colleagues. I asked them to feel in themselves for their balance, sensation in their feet before, during and after the exercises. Someone felt it in the back, another in the core,.. . Thats what I wanted to achieve that my audience gets aware of the relevance of a good foot mechanics and how this affects the muscle tone and posture of the body.
With presenting this tutorial I revised foot differentials but also worked on my presentation skills. I have both revised my anatomy/pathophysiology knowledge and worked on my confidence to give lectures for a group with todays clinic tutorial. To use and make more out of this experience I provided all participants with a anonymous survey monkey questionnaire to collect feedback on my presentation skills.
This afternoon I joined another new patient clinic. To be in the role of the examiner is a good change to prepared for my CCAs as I focus during this process on the required points for the final CCAs. Afterwards we sat together and discussed the feedback.We got some very useful advice from our tutor. For instance that we should place the case history by the side when presenting as this really helps us to focus and summarise the main points. But also that we should try to gather more information before we write it down otherwise when we stop for each section we would interrupt or communication and with this the flow of the case history. I really appreciated our feedback session afterwards and keep some spare copies of the new patient feedback sheet so that I can ask an observing colleague for feedback on my performance.
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