Tips for Success as a Clinical Instructor in the Home Setting

By Alex Germano PT, DPT

Physical Therapist

Finally, you’re on the other side. You get to be the one in charge, the head honcho, the shaper of young PT minds. Being a clinical instructor is an exciting time — and a little intimidating. You’re likely to be full of questions: “Will I help this person become a better PT?” And, “Will they learn something from me?

As clinicians with FOX Rehabilitation, we are constantly on the move, traveling house to house all day long. Due to the on-the-go nature of our job, we have different clinical instructor/student relationships and have different ways of maximizing the student’s experience. Students spend every moment with their instructors at FOX, unlike a traditional outpatient clinic. Because of this, we have many more interactions, time for discussion and feedback, and ample opportunity to create meaningful relationships. For example, we have planned downtime as we drive to a patient’s house. Using this time appropriately can help improve the student’s performance for the next session.  I have been both a student and clinical instructor with FOX, and I am excited to share with you what I have learned.

How to be a Confident Clinical Instructor in the Home Visit Setting

Maximize Drive Times For Learning Opportunities

One of the most unique aspects of our jobs is having to drive between patients. This allows you and your student to get about 5-10 minutes of uninterrupted time between patients. Unlike a normal outpatient clinic where the next patient is waiting, you have time between to decompress, discuss performance, and plan for the next session. This time is vital to the learning experience of the student. Take time to explain their areas of strength and potential growth, walk through what the next session will look like, and answer any questions they may have. As your student becomes more proficient, plan to listen to a physical therapy podcast to continue to learn on the road. Some of my favorite podcasts include GEROS Health, PT Pintcast, PTonICE, APTA. 

Proactively Schedule Document Review

In the home setting, there are variable start times and less scheduled time for documentation or lunch. This can cause the day to feel very paced for a student. To help slow down the day,  it is extremely valuable to block off 15-30 minutes each morning to review documentation together. Actively reviewing documentation together enables students to learn the document system more quickly. Not only that, but the student’s documentation becomes more accurate and complete at the time of service. This is also a way to connect before the day gets busy, establish daily and weekly goals and prep for the patients of the day.

Use Google Docs For Easy Sharing

One of my favorite ways to communicate is using google docs. Again, because our work at FOX doesn’t involve having a physical clinic it can be hard to communicate and ensure both the CI and students are on the same page with patient exercise programming and goal setting. I usually set a Google Doc up at the beginning of the clinical. This creates a space where both my students and I can review important topics regarding the clinical. In this document, we put in the student’s weekly goals, strengths, and areas for improvement.

We also use this document to program for our patients (in a HIPAA compliant manner). I have my student plan a week of programming for each patient so that we can continue to develop the skill of planning progressively challenging sessions at appropriate exercise intensities. I also have the student pick an article of the week that pertains to the treatment of one patient. The student will list this in their week of programming and we review the article together. We also use this article in our documentation for the week to help strengthen our clinical reasoning.

Fight Ageism One Clinical at a Time

We at FOX are in a unique position, working on the front lines to fight ageism. Unlike many clinics, students will be working primarily with older adults. It is our role as clinical instructors to get our students comfortable interacting with aging adults. Doing so can help the students believe in the strength of this population. I typically recommend the students to explore content created by Ashton Applewhite. This can include her TED talk or book. She is an incredible resource for understanding the impact ageism has on our profession. I also like to take time to discuss and challenge prior misconceptions about exercising with older adults as well as areas where they may feel ageist. It definitely changes a student’s perceptions when I bring 35# kettlebells into a 90-year-old patient’s home and have them deadlifting!

Involve in Scheduling

During my own clinical with FOX, I have not actively involved in scheduling/planning the daily route. I wonder how many of you out there did or did not perform scheduling? I also did the same with my first student. Upon further examination, I believe that schedule making should be involved in the student’s clinical experience. It can be a brief lesson but having them understand how to schedule patients is a vital skill to being a home visit clinician. I don’t think you would be giving them the full experience without including this part!

Have the Student Shadow

One of the best parts of working in this setting is the co-workers who work their magic on a daily basis. Find two days during the clinical to send your student with the occupational, physical or speech therapist. This can greatly enhance their understanding of multi-disciplinary care. If you could have them shadow the clinician on a day when they see patients you share, even better! I also recommend including them for team meetings, doctor’s lunches, and journal clubs.

Show the Student Creative Interventions

Clinicians working in patients’ homes are some of the most creative out there. The things I have seen OTs, PTs, and STs come up with are astounding. We have an amazing opportunity to show our students innovative treatment ideas using the equipment we bring to patients’ homes – or things present in the home. Students don’t often get the opportunity to think outside the box like this. Students are also a great resource for coming up with new interventions. They come with a new perspective and knowledge. One particular student brought in circular floor markers for stepping games. I quickly added them to my own treatment rotation and have found them to be extremely useful!