Choosing a Placement

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Choosing a Placement

• A few tips to make the process easier

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• Please note the explanations given are what
  typically happens at most hospitals in a given
  service. You are not guaranteed to see/care for
  everything that is mentioned. This is merely a
  guide of what you could come across.

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What to choose??

• Can be a very stressful time for some students.
• Should really be an exciting time.
• How best can you meet your requirements and get
  the best clinical experiences possible to stand
  you in good stead for the PNE and your future
  practice

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The Process

• Consider your outstanding requirements
• Think about your areas of interest and see if you
  can fit that into your requirements
• Review the offers available in the areas you have
  requirements
• Read the placement profiles on the Clin Ed
  website to see what is involved in each placement
• Make your choices and then revisit the database
  closer to the run
• RELAX

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Database

• When making your choices, out of your 10 you may
  only choose two offers at any given site this
  will hopefully allow for a more fair run.
• You may only complete two placements per site and
  they must be different services/areas of
  practice.
• You will leave Edmonton for at least one
  placement but most students end up completing 2
  or more placements outside the greater Edmonton
  area.

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Requirements

• Acute Care
• Community
• Private Practice/ Out Patient Ortho /
  Occupational Rehab (Millard)
• Alberta Adventure
• CardioResp 40
• Neurology 40

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Acute Care

• Typically involves
• A large urban hospital
• Acutely ill / emergent patients
• Surgical
• Medical
• Critical Care
• Rehab
• Ambulatory clinic follow ups for Med/Surg
  patients with Internist/Surgeon
• Interdisciplinary team

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• Many diverse fields of practice in which PT is
  involved
• Many other health care providers striving for a
  common goal of patient well being, healing,
  compassion, and or palliation

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Acute Care Services - Medicine

• General Internal Medicine
• Typically adults and older persons, occasionally
  younger adults with complex medical problems
• COPD exac, Pneumonia, Acopia and Falls, CVAs,
  generalised problems relating to DM,
  Malnutrition, Poor compliance with meds, and some
  people that just need a tune up. Also may see
  people following discharge from ICU.
• Typically Assessment, Treatment (strengthening,
  balance training, functional activities,
  mobilisation, discharge planning for home,
  equipment (Mobility aids etc) ordering. Typically
  you will have opportunity to use your CardioResp
  and possibly Neurological skills.
• Lots for InterD team work with SW, OT, Dietician,
  Pharmacists, SLP, RNs and MD.
• A very rewarding service, you enable people to
  return to their own homes with INDEPENDENCE

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Acute Care Services - Medicine

• Nephrology/Renal
• Adults and some older adults. Occasionally
  younger adults.
• Patients with kidney disease. On one form of
  dialysis (IHD, Peritoneal etc). Typically
  sequelae of DM. Renal disease is quite
  debilitating and draining. Patients dont usually
  have a lot of energy following dialysis. Really
  benefit from exercise and strengthening. Can lead
  productive lives and are able to live
  independently. Are prone to infection.
• Will involve, assessment, treatment
  (strengthening, exercise prescription,
  maintenance programs), D/C planning, equipment
  ordering. You will be using CardioResp skills
• InterD teamwork, SW, OT, RN, MD.
• You are enabling independence and improved
  function

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Acute Care Services - Medicine

• Pulmonary/ Respirology
• All ages across the adult spectrum
• Typically patients with COPD exac, post ICU,
  patients with long term ventilator requirements
  or straightforward weaning. Patients with
  traches, CF, pneumonia, interesting/obscure lung
  conditions. Lots of chest assessment,
  auscultation, treatment (vibes, percs, breathing
  exs, resp muscle training, general
  strengthening, suctioning), equipment ordering
  and D/C planning
• InterD work, OT, SW, SLP, RN, Pharmacist, MD.
  
• You will really be able to hone your cardioresp
  skills

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Acute Care Services - Surgery

• General
• All ages across the adult spectrum
• Variety of conditions cancer, bowel
  obstructions, internal bleeding, elective and
  emergent surgery. General surgery typically
  involves the abdomen
• Will involve assessment, treatment (typically
  cardio resp skills, strengthening, mobilisation,
  perhaps equipment ordering, and D/C planning.
  Involves chest care and lots of mobilisation to
  prevent complications. Patients typically will
  have lines, tubes and drains
• Will involve InterD teamwork and D/C planning

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Acute Care Services - Surgery

• Specialised surgery
• All ages across the adult spectrum
• Will involve specialised surgery on specific
  areas of the body ENT, Head and Neck, Plastics,
  Urology, Thoracic etc. Will involve cancer,
  malformations, obstructions and repairs.
• Will include assessment, treatment (cardio resp
  skills, education, mobilisation, strengthening)
  and D/C planning
• InterD teamwork OT, SLP, SW, RN, MD

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Acute Care Services - Surgery

• Orthopaedic Surgery/Trauma
• Ages across the adult spectrum, typically older
  adults for cold fractures, younger in traumatic
  injuries
• Will involve joint replacements, mainly hips
  and knees. May involve cold trauma a fall
  resulting in a fracture that requires fixation
  and hardware. May also involve a trauma service
  which would deal with patients post MVA,
  workplace injuries
• Will involve assessment (should involve some form
  of cardio resp assessment in addition to ortho
  assessment), treatment (strengthening, ROM,
  mobilisation). Often includes best practice care
  paths. Crutch walking, equipment prescription and
  ordering, D/C planning
• InterD teamwork

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Acute Care Services - ICU

• All ages across the adult spectrum, occasionally
  paeds if facility has no paediatric ICU
• A whole variety of conditions acute medical
  patients, major surgical and transplant patients,
  lots of trauma, multiple organ failure
• 11 nursing, intense observation. Some very
  actutely ill patients
• Assessment, treatment ( cardioresp
  percs/vibes/positioning/ strengthening and
  mobilisation, possibly some neuro, ortho. Not
  much D/C planning as patients tend to go to ward.
• InterD environment, MD, RN, OT, SLP,
  Pharmacist, Dietician, RT and many specialist
  techs
• Although daunting is the safest place to work,
  doctors around 24/7

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Acute Care Services - Neurology

• Neurology
• All ages across the adult spectrum
• Patients with CVAs, acute spinal cord injuries,
  MS, ALS, GBS, PD, ABIs.
• Will involve assessment and reassessment,
  treatment (neuro skills, balance, coordination,
  function, strengthening, quality of movement,
  outcome measures) D/C planning, Equipment
  ordering, occasionally home visits. Rehab usually
  has big input about D/C, appropriateness for
  Rehab Hosp/LTC etc. You will be able to hone your
  neurological skills and possibly some cardioresp,
  perhaps some inpt ortho
• InterD work with SW, OT, SLP, RN, MD. PTs.
• Really dynamic and exciting services. Big impact
  on function and quality of life -

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Acute Care Services - Neurology

• Neuro-surgery
• Typically adults and younger adults, all ages in
  adult spectrum
• Usually traumatic injuries that require surgical
  intervention where the brain or spinal cord are
  involved. Following MVA or falls. May also be
  elective surgery for brain tumour or aneurism
  clipping. Could involve spinal surgery following
  trauma, which may or may not have resulted in
  quad/paraplegia
• Assessment (typically, neuro, cardioresp and
  ortho assessment), treatment (neuro skills,
  balance, strengthening, mobilisation, functional
  outcomes, cardioresp esp in SCI and ortho
  skills) D/C planning and equipment ordering.
• InterD teamwork OT, SW, SLP, RN, MD
• Big impacts on function and quality of life

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Community Placements

• All ages across the adult spectrum
• Conditions you may see include cerebral palsy,
  acquired brain injury (ABI), stroke, spinal cord
  injury, Parkinson's disease, COPD, muscular
  dystrophy, pneumonia, joint replacements
• Typically complex patients
• Will really test your skills and challenge you
• May be in a rehab facility (eg Glenrose, Dr
  Vernon Fanning) , could be in a school setting,
  long term care facility, home care, day programs
• Will involve lots of assessment, treatment ( will
  involve neuro skills, cardio resp skills and
  ortho skills, strengthening, balance training,
  mobilisation working on quality of movement and
  functional outcome measures. May involve
  suctioning traches. Will involve home programs,
  maintenance programs, individual treatment and
  class and group activities), equipment ordering,
  D/C planning and possibly home visits.
• Involves InterD work with OT, SLP, SW
• Challenging placements that require integrated
  critical thinking skills

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Community Placements

• Long term care
• Nursing home residents with complex problems
  requiring assistance from nursing staff
• Require assistance with ADLs, are unsafe to live
  on their own
• Often have multiple medical problems. May have
  some sort of dementia component.
• Perhaps will be on O2, may have traches that
  require suctioning
• May have mobility limitations
• Assessments and treatments, looking at
  maintenance programs as well as trying to improve
  function so patients could return home or to a
  facility requiring less direct care

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Community Placements

• Home Care
• Bridges the gap after discharge also frees up
  hospital beds for more acute patients
• Patients discharged home but still require rehab
  to return to previous level of function.
• Patient unable to attend out patient program
• Could be checking in on patients with chronic
  diseases that require on going assessment,
  treatment and home program prescription
• Aim is for independent function and managing
  condition in their community

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Private Practice/OP MSK/ Occupational rehab

• Typically private clinics but some hospital based
  OP clinics
• All ages across the adult spectrum, typically
  younger adult
• General MSK conditions/injuries, necks and backs
  as well as peripheral joints, sports injuries,
  work place injuries, repetitive strain injuries.
  Some practices do some Cardioresp and Neuro
  treatment although this is rare
• Assessment, treatment (manual therapy, ther Ex,
  EPAs, home exercise programs), consultations
• Possibility of discussion with referring doctor
• Most Private Practices are not recommended for
  first placements

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Alberta Adventure

• Your opportunity to get out of the big city and
  go on an adventure
• Think outside the box, see the province, wind
  down
• Community hospitals and small community programs
  offer a very different perspective on patient
  care
• All ages across the adult spectrum
• Typically a very mixed case load
• Most certainly some form of Cardioresp, possibly
  neuro, MSK
• May involve some LTC/HC
• Small facilities everyone will know who you are
• Please read the merits of rural practice
  section in the clinical practice handbook or
  watch the student interview video-Who would have
  thought my first job would be in rural AB? on the
  Clin Ed website under Alberta Adventure.

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• Think about your requirements
• Consider your requirements when making placement
  choices. Besides that, strive for diversity.
  There are many settings and each offers both
  unique experiences and an opportunity to build
  your core PT skills
• VARIETY is the spice of life and makes for a
  well-rounded PT!!
• YOU and your attitude are key for a successful
  placement!!
• Have Fun and Good Luck