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Student-run PT clinic provides experience, chance to learn from patients

Eric Knoth, left, talks about his physical therapy plan with Creighton third-year PT students, Cydney Nagridge, Jon Free and Kevin Giordano.The 90 minutes Eric Knoth drives, once a week, from his home in Iowa to the student-run physical therapy clinic at Creighton University is, in Knoth’s estimation, time well spent.

“I come for the quality,” said Knoth, who is rehabilitating from a stroke. “Getting here once a week, I feel like I get a one-on-one experience with three different therapists in a setting I enjoy and doing exercises I enjoy and that challenge me. I’m happy to make that drive.”

In a new Doctor of Physical Therapy curricular component, the students participate in a five-week, gratis, student-run clinic. The 60 third-year PT students, work in three-person teams with a faculty or PT resident mentor and focus on one patient once a week.

The one-to-one care and the collaborative model of the clinic makes for a vital learning environment for the students, a setting where, in addition to the guidance of the faculty or PT resident mentor, the patient also serves as a crucial educator in the process. Being able to work collaboratively, concentrate on evidence-based approaches and conclusions, and having refined time for patient interaction has made the clinic a fertile proving ground as students enter their final year of study.

“It’s a community of practice,” said Jenny Bagwell, PhD, an assistant professor of physical therapy in the School of Pharmacy and Health Professions. “The community works to the mutual benefit of patients and students, and even for the mentors, it’s a good experience all around. It’s been exciting to see what they’ve accomplished. Even in five weeks, which is a short amount of time in PT, there have been some substantial improvements for patients and the students are learning a lot about collaborative, one-to-one care.”

The clinic is being offered on a complimentary basis to patients who have been involved with other Creighton PT clinics or through contacts with Creighton faculty or PT residents. Bagwell and Kimberly Beran, DPT, also an assistant professor in the Department of Physical Therapy, helped organize the clinic, sought out its first patients and arranged the clinic schedule and staffing.

“Our objective was to create an authentic, genuine learning environment that was mutually beneficial to the students, patients, mentors and residents,” Beran said. “I feel like we were able to obtain this objective.”

Having been through at least one round of PT, the patients in the student-run clinic are now getting added attention in the weekly sessions, usually with some take-home exercises to continue building strength or working on balance and gait.

For the students, there’s an exercise in engaging with one another, the patient and their faculty or PT resident mentor. As Knoth went through his exercises in the clinic, the three students treating him gave one another useful hints and encouragement.

“Working with your classmates is a big part of the process,” said third-year PT student Cydney Nagridge. “But there’s also the patient who is directing you and telling you what’s working and what’s not. It’s different from your classmates simulating something. It’s real life. You’re working with a patient, with a group of people, in a way that’s pretty close to how work looks in a clinic.”

One patient, Warren “Tim” Kable, MD, is no stranger to educating budding health professionals. An emeritus associate dean and professor in the School of Medicine, Kable is working to build strength and balance after a stroke.

“The exercises are fun and I like to see the students,” Kable said. “And, as a physician, I just wanted to help. All of my learning and teaching has led to this, that they can learn and teach themselves. They can find the answers.”

Kable’s wife, Karen, said not only has her husband improved physically, but the students have boosted his self-confidence. “There’s been such a remarkable change in him through working with these students,” Karen Kable said. “They have shown him and me how to make exercise fun and motivational, and how it can build your confidence and abilities. It’s been a great blessing to us.”

Even in the brief five weeks of interaction between students and patients, marked progress took place. Students were able to engage their patients individually and work on specific elements of rehabilitation, aiming at helping the patient reestablish participation in daily activities and pastimes they particularly enjoy. In a recent session, students saw a young patient take his first steps.

Third-year students Lyndsay Provencio, Ellie Toscan and Jacob Kmiecik worked with a patient focusing on balance and gait while walking.

“Obviously, in such a short amount of time we don’t see a ton of quantitative improvement but there has definitely been an improvement in quality of movement for the patient we’ve been working with,” Provencio said.

“I feel like we were able to treat the whole patient,” Toscan added. “He liked to walk outside, so we tailored the exercises toward his activities and, adjusting the treatment for that, he said he was able to enjoy more walking outside.”

Now that the student-run clinic has been established, Bagwell said the hope is to keep it running and perhaps expand the number of patients students see. At the moment, Bagwell said space is the main limitation to seeing more patients. A series of surveys and focus groups among patients and their family members will also help direct improvements in the clinic.

“We came into this thinking that if we could make even a little change in a patient that’s continuing his or her therapy, it was worth it,” Bagwell said. “But to see what’s happened in this short amount of time has been encouraging. The students have certainly enjoyed it and the patients, I think, have responded very positively. It’s another example of how the Ignatian values at Creighton are at work in treating the whole patient and in giving students a hands-on, collaborative educational experience.”

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