Transitioning to Clinical Care

Clinical rotations are a critical part of physical therapy education. They provide the opportunity to apply classroom knowledge in real-world settings, develop clinical reasoning skills, and build professional relationships. Many students want to stand out, make a positive impression, and maximize their learning. This article outlines key strategies to help students succeed in clinicals while maintaining a professional and confident approach.

1. Show Up Prepared

Preparation is about more than just arriving on time. A proactive approach before stepping into the clinic each day can make a significant difference.

• Research the Setting: Understand the patient population, common conditions, and interventions used in the specific environment. Each specialty will have unique considerations, here are just some basic ideas from common settings.

  • Orthopedics: Review special tests and manual therapy techniques.

  • Neurology: Familiarize yourself with standardized outcome measures and CNS/PNS anatomy.

  • Inpatient Rehabilitation or Acute Care: Understand common precautions/contraindications for exercise, lines, and monitoring equipment.

• Review Patient Charts (If Possible): If access to patient charts is available before treatment, reviewing history, medications, and precautions can help anticipate patient needs and guide decision-making.

• Utilize a Clinical Cheat Sheet: Keeping a quick-reference sheet can be helpful, especially for areas that require frequent recall.

  • For example, I have an inpatient neuro rotation coming up, and I created a cheat sheet that includes thresholds for blood pressure, heart rate, respiratory rate, hematocrit, hemoglobin, oxygen saturation, and glucose levels relevant for therapy contraindications. These numbers can quickly get confusing and mixed up while working with patients and the cheat sheet allows me to be more efficient and confident when treating.

  • Customize the Cheat Sheet to Personal Needs: If gait analysis is challenging, include common gait deviations and their associated impairments. If medications are still tripping you up, make a list of common drug classes, their suffixes, and general side effects to be aware of. What’s even better is lots of these cheat sheets already exist on the internet and are ready for printing!

2. Be Proactive, Not Passive

Students who take initiative tend to gain more from their clinical experience. Being engaged and prepared to contribute allows for a more meaningful learning process.

• Ask Thoughtful Questions: Instead of asking, “What should I do next?” consider framing questions in a way that demonstrates critical thinking.

  • “I was considering using [treatment option]. Does that seem appropriate for this patient?”

  • “Would it be beneficial to focus on motor control before progressing to strengthening in this case?”

  • “I’ve seen [technique] used in similar cases—do you think it’s applicable in this setting?”

  • Also, seek understanding when asking questions. Many times a CI may give an answer that goes against what you have been taught at school. Rather than immediately pushing back on the idea, ask more questions, understand the CI’s thought process and then come to a conclusion on the proposed solution. If the answer truly goes against evidence-based therapy practices, come back to your CI with peer-reviewed studies and more information about your intervention. Students often undervalue their knowledge, but recognize that we are on the cutting edge of this practice. Most of our education is, or at least should be, on the most up-to-date research in examination and treatment. Advocate for your patient’s care.

• Assist with Small Tasks: Setting up treatment spaces, grabbing equipment, or preparing the next session demonstrates initiative and professionalism.

• Take on Small Responsibilities Early: Leading patient warm-ups, educating on home exercises, or assisting with transfers builds confidence and establishes trust with both the clinical instructor (CI) and patients.

• Study Outside of Clinicals When Needed: I know it is hard to review after a full day of work, but even 30 minutes of review can save hours of time in the clinic. If a patient presents with a condition that is unfamiliar, reviewing relevant research, anatomy, or treatment strategies outside of clinical hours can be beneficial.

  • Example: If a patient has unilateral neglect following a stroke, reviewing evidence-based interventions before the next session can improve clinical reasoning and demonstrate your willingness to learn and adapt.

  • If pediatric sensory integration techniques are challenging, reviewing case studies or educational videos can provide further insight.

3. Effectively Receive and Apply Feedback

Clinical instructors provide feedback to guide student development, but how feedback is received and implemented can significantly impact the learning experience. Developing strong communication with your CI and being intentional about feedback can make a major difference in your growth during clinical rotations.

• Seek Feedback Early and Regularly – Rather than waiting for midterm or final evaluations, make feedback a daily conversation. This can be as simple as asking, “What’s one thing I did well today, and what’s one thing I can improve for tomorrow?” These discussions can happen at the beginning of the day to establish goals or at the end of the day for reflection. However, this starts with quality communication upfront between you and your CI. Set expectations early by discussing what you hope to gain from the rotation and how you best learn. If your CI knows your learning goals, they can tailor feedback to help you develop in those areas rather than just assessing your general performance.

• Communicate How You Prefer to Receive Feedback – Not every student learns the same way, and not every CI automatically knows how to deliver feedback effectively for you. Some students prefer immediate, in-the-moment corrections so they can adjust on the spot. Others learn best by experiencing a session fully, then receiving feedback afterward so they can reflect and improve. Let your CI know what works best for you. Don’t assume they can read your mind, tell them. Being upfront about how you process feedback can save a lot of frustration and misunderstandings, and in some cases, it can prevent unnecessary tension in your professional relationship.

• Do What You Say and Apply the Feedback Given – The fastest way to lose trust with your CI is to receive feedback and never act on it. If they take the time to guide you and you repeatedly fail to apply their advice, it may come across as disinterest, a lack of understanding, or, worse, that you don’t care. Instead, take what they say, reflect on it, and actively implement their suggestions in the next session if applicable. Even better, go a step further and seek additional information on the topic, whether through research, textbooks, or discussions with other clinicians. When your CI sees you making adjustments and improving based on their feedback, they’ll respect your initiative and be more invested in helping you grow.

4. Building Strong Patient Rapport

Technical skills are important, but patient engagement and trust are equally critical for successful therapy outcomes.

• Communicate Clearly and Concisely: Use terminology that patients can understand. If they seem confused, reframe the explanation. Health literate terminology allows patients autonomy in their own care and gets more buy in over being told what to do.

  • Instead of: “We’re doing scapular retractions to activate your rhomboids.”

  • Try: “These exercises will help improve your strength and decrease your shoulder discomfort.”

• Listen Actively: Patients are more engaged when they feel heard. Asking about their goals and daily challenges provides insight into how therapy can be tailored to their needs. This is a section that is often overlooked and its return is powerful for a 3-5 minute conversation.

• Encourage Self-Efficacy: Instead of simply instructing patients, explain why each component of therapy is beneficial. Patients who understand the reasoning behind interventions are more likely to remain engaged in their rehabilitation.

5. Get Over Yourself and Be a Team Player

Physical therapy is a team effort, and the best clinicians know that everyone has something to teach. Clinical rotations are not about proving what you know, they’re about learning from everyone and doing what’s best for the patient.

• Stay Humble and Learn from Everyone – PTAs and aides often have decades of hands-on experience and can offer valuable insights on patient handling, cues, and clinic efficiency. Being open to their advice can improve your skills and make you a more effective clinician.

• Support the Team to Improve Patient Outcomes – A well-run clinic depends on teamwork. Helping fellow students, PTAs, or aides improves efficiency and ultimately benefits patient care. This isn’t about ego, it’s about ensuring the best outcomes for those we serve.

• Adapt to Schedule Changes and Use Downtime Wisely – Cancellations happen. Instead of waiting around, offer to help another clinician, observe a complex case, or review patient charts to improve your next session. A flexible, team-oriented mindset sets you apart.

The best way to stand out? JFK said it first: “Ask not what your clinic can do for you-ask what you can do for your clinic.”

Parting Thoughts:

The key to excelling in clinical rotations is not about knowing everything, but rather demonstrating initiative, adaptability, and a willingness to learn. Clinical instructors appreciate students who are engaged, prepared, and proactive in their approach. By focusing on strong patient interactions, thoughtful clinical reasoning, and teamwork, students can leave a lasting positive impression while gaining the skills needed for future practice.

We would love to hear any other words of advice from current or past students. Also, if any CI has helpful tips for students, those are greatly appreciated too!

Disclaimer:

I am a current Doctor of Physical Therapy (DPT) student sharing information based on my formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While I strive to provide accurate and up-to-date information, my knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.