Critical Thinking

A Week in the Life of a Fellow

Justin D

Have you been considering fellowship and wondering what a week in the life of a fellow-in-training is like?  This journal post was written by Dr. Justin Deskovich, who is a fellow-in-training at Sports Medicine of Atlanta (an affiliate of NxtGen Institute of Physical Therapy) to do just that.

By: Justin Deskovich, DPT, OCS, SCS, CSCS

Monday

Morning:

Arrived and reviewed orientations of case load and met staff

Mentored in house resident on live patient evaluation

My task was to integrate the residents didactic and core practical curriculum into a clinical learning experience

Demonstrated lateral shift correction on live patient for mentor Dr. Robert DuVall

Highlighted A:1 to A:6 on live patient initial evaluation

A:1 Medical Screening Hypothesis

  1.  Visceral
  2. Psycho-Social
  3. Orthopedic Medical

A:2  Movement Diagnosis Hypothesis

A:3  Pathoanatomical Diagnosis (ICD-10)

A:4  Functional Limitations

A:5  Etiological Variables

  1. Biologic
  2. Environmental

A:6  Prognosis

Afternoon:

Delivered Power Point Lecture on independent study course (ISC), in-service for in-house Resident on hip osteoarthritis and manual physical therapy

Highlighted Medical Screening

Highlighted the contemporary clinical practice series clinical decision making algorithm

Completed one live new-patient initial direct access consultation with mentor Dr. Robert DuVall

Evening:

Performed two more live new-patient initial direct access consultation with mentor Dr. Robert DuVall

Performed four biomechanical vitals examinations with mentor Dr. Robert DuVall

Discussed how planter foot callus formation provides dynamic functional data and is more powerful than an MRI
Driven by the subjective finding of “palpitations”, I observed and performed mitral valve prolapse and thyroid medical screening examinations after observing my mentor Dr DuVall execute these medical screening physical exams

 

Tuesday 

Morning:

Completed one live initial consultation with mentor Dr. Robert DuVall

Performed elbow, wrist, and hand mobilizations with mentor Dr. Robert DuVall

Documented initial evaluation on Web PT

Demonstrated glenohumeral (GHJ) mobilizations on live patient case for Dr. Robert DuVall

Completed biomechanical vitals examination with Dr. Robert DuVall

Demonstrated anti-medial rotation syndrome mobilization series with mentor Dr. Robert DuVall on live patient with lateral patellar compression syndrome

Afternoon:

Reviewed each new patient case with mentor, Dr DuVall

Discussed the importance of therapeutic alliance

Displayed therapeutic alliance on live patients with mentor Dr. Robert DuVall

– Discussed Pain Sciences clinical competence and relevance in regard to a 13 year old patient who had polydactyly and underwent bilateral amputation of her sixth digits at her hypo-thenar eminences at 6 months of age; who, now has pain and neurological symptoms over her hypo-thenar eminences.

– Examined patient for symptoms and signs of Central Sensitization, administered “Recognize” testing tool via i-Phone 5.

Demonstrated competency in neurodynamic testing on live patient with polydactyly

Demonstrated competency in teaching self-ulnar nerve glides on live patient with polydactyly

– Discussed role of Graded Motor Imagery interventions.

Demonstrated competency in GHJ mobilizations on live patient with humeral anterior glide syndrome with mentor Dr. Robert DuVall

Evening:

Witnessed dry needling to thoracic and lumbar paraspinals on live patient

Taught PT Interns supine lumbo-pelvic roll, seated thoracic distraction manipulation, seated cervicothoracic distraction manipulation, and supine P/A thoracic manipulation

Performed live new-patient initial direct access consultation with mentor Robert DuVall

Demonstrated proficiency in administering functional movement screening on a runner

Performed live patient biomechanical vitals examination with mentor Dr. Robert DuVall

Guest lectured virtually and live over Blackboard and delivered my second Power Point Lecture, this time teaching “Direct Access: Primary Care for PT” as a core course in the curriculum for transitional t-DPT students from Alabama State University

Wednesday 

Morning:

Completed live new-patient initial direct access consultation with mentor Dr. Robert DuVall

Demonstrated cervical myofascial release and neuromuscular re-education series, thoracic mobilizations, and GHJ mobilizations with movements with mentor Dr. Robert DuVall on live patient

Demonstrated hip mobilizations on live patient with mentor Dr. Robert DuVall

Taught DPT Interns hip long axis distraction, prone FABER’s hip mobilization, P/A hip mobilizations and hip inferior and inferior lateral thrust manipulations

Completed biomechanical vitals examination on live patient with Dr. Robert DuVall

Afternoon:

Demonstrated proficiency in functional progressions for mentor Dr. Robert DuVall on live patient with a movement diagnosis of lower extremity medial rotation syndrome

Demonstrated proficiency in performing side-lying lumbar roll manipulation on live patient with medial rotation syndrome with mentor Dr. Robert Duvall

Reviewed medical screening examination sequence with mentor Dr. Robert DuVall

Discussed importance of direct access to the profession of physical therapy with mentor Dr. Robert DuVall

Demonstrated how to re-set the muscle spindle followed by functional progressions on a live patient with mentor Dr. Robert DuVall

Evening:

Completed live patient initial evaluation with mentor Dr. Robert DuVall via Direct Access

Performed upper cervical spine ligamentous stability testing with Dr. Robert DuVall

Taught DPT Interns upper cervical ligamentous stability testing

Taught DPT Interns mid-cervical upslope and down slope manipulations

Discussed cervical compressive myleopathy (CCM) case presentation, CCM signs, CCM symptoms, medical management, and physical therapy interventions.  Discussed CCM with Dr DuVall

Thursday 

Morning:

Performed side lying sciatic nerve glide with DPT Intern to assist patient with lumbar flexion with bilateral rotation syndrome

Demonstrated humero-ulnar joint mobilizations on live patient with mentor Dr. Robert DuVall

Demonstrated wrist and hand mobilizations on live patient with mentor Dr. Robert DuVall

Demonstrated Mulligan mobilization with movement for lateral elbow pain with mentor Dr. Robert DuVall

Demonstrated the ability to differentiate between psoas major versus rectus femurs length testing during the Thomas test on live patient with mentor Dr. Robert DuVall

Afternoon:

 

Displayed competency on all three medical screening hypothesis components with mentor Dr. Robert DuVall

Completed orthopedic manual performance proficiencies with mentor Dr. Robert DuVall

Demonstrated return visit patient interview, manual therapy, and functional progressions on live patients with mentor Dr. Robert DuVall

Discussed importance of including temporomandibular joint (TMJ) evaluation and treatment in my curriculum to satisfy all diagnostic categories.

– Discussed and reviewed supplemental resources available to satisfy TMJ diagnostic categorical requirements for fellowship standards to be met

Demonstrated competency in proving feedback on treatment progressions to DPT Interns

Evening:

Discussed my Fellowship program’s curriculum at mid-term with Fellowship program director  Dr. Robert DuVall and curriculum coordinator Dr. Francois Prizinski

Discussed remaining goals and objectives that must be met to meet AAOMPT requirements with Sports Medicine of Atlanta’s program director Dr. Robert DuVall and curriculum coordinator Dr. Francois Prizinski

Discussed live patient cases with mentor Dr. Robert DuVall

Graded on live patient cases with mentor Dr. Robert DuVall

Reviewed all graded curricular assignments by mentor Dr. Robert DuVall

Friday 

Morning:

Demonstrated competency on medical screening for visceral, psychological, and orthopedic medical for mentor Dr. Robert DuVall

Observed Dr. Robert Duvall medically screen patient with abdominal right lower quadrant pain and concomitant LBP by auscultating and palpating her abdominal aorta and palpating for “Rebound tenderness” on live patient

Discussed the only four medical emergencies that you would stop the examination and send a patient to the emergency immediately

1) Patient report of black tarry stool

2) Myocardial infarction

3) Cerebral vascular accident

4) Presence of rebound tenderness

Demonstrated gait training, manual therapy, and exercise progression on a patient with central sensitization who underwent three knee surgeries

Afternoon:

– Discussed the regionally inter-dependent finding and the clinical logic that define PTs unique body of knowledge

Observed orthotic molding by mentor Dr. Robert DuVall on live patient with lumbar flexion and rotation syndrome

Differentiated the difference between a patient with a C versus S curve with mentor Dr. Robert DuVall

Completed clinical decision making model diagram for upper and lower extremities

Demonstrated competency administering APTA’s CPI tool on student interns with mentor Dr. Robert DuVall

Observed mentor Dr. Robert DuVall perform positional distraction in side lying

-Participated and contributed to the performance and review of presenting the final findings on a Clinical Performance Instrument for a Duke entry-level DPT Intern.  Whereby, discussed the unique body of knowledge that defines PT and how to best actualize this unique body of knowledge via the use of “Movement Based Diagnoses”, per the research of Dr Steven Rose. And, how PTs unique body of knowledge actualized via the provision of movement based-diagnoses warrants the PTs role in the delivery of PT services via Direct Access.

Evening:  

Headed back to Pittsburgh from Sports Medicine of Atlanta

Performed introspection on a week in the life of a fellow at Sports Medicine of Atlanta

Performed meta-cognition on a week in the life of a fellow in training

– Reflected on Davis Butler’s model introspection of his own career at the 30+ year anniversary of his professional legacy.

Completed a check list of remaining objectives needed met to complete fellowship

Reached Chalk Hill, PA for a good night’s rest

 

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