Dr McClellan

Dr. McClellan,

I hope this email finds you well. Please accept my apologies for not being able to make it on our phone call appointment today. Things just get too busy in the hospital unexpectedly. Please be advised that I have CC’d Dr. Song and Dr. Medendorp in this email as well.

Last Sept 18, Wednesday, we did an evaluation on a patient in the ICU. My student, Joe Brown and a student OT were co-evaluating the patient under the supervision of myself and the assigned OT. We had just ambulating the patient and we are the conclusion of our session. We are merely reattaching lines back to how it was. I have asked Joe to reattach the temperature probe (continuous physiological monitoring). He then said that he did not disconnect that line. I replied to him that it is on my knowledge that I have asked the OT student to disconnect that line before we moved the patient but that has originally been attached to the foley cath and now I am merely asking him to reattach it. He replied that he does not know where to reattach the line and because he was not the one who detached in the first place. I am so puzzled since in my recollection, this is a line that he is very well familiar with. I replied okay, I'll let you find it, just follow the foley cath and you will find a probe for you to connect the line. I am at the opposite side of the patient, distant from the foley for me to physically do it myself. I was a mere supervisory request. He did not take that too lightly. Argumentatively in front of the patient, he insists that he did not disconect that in the first place and so he does not know where to find it. He started to shake on his hands and on his fingers, clearly he is mad. I just let it slide. It would look unprofessional for me to reply to such remarks. The session was over.

We discussed how the session went with the students and to provide our personal feedbacks. Joe did not take that lightly and was very defensive on his response. I pulled him on the side so that we could discuss things in private. Joe did not liked that either. In defense of himself, he did not take that feedback very well. He said he only have seen that temp probe twice and this is the third time and that he did not disconnect the probe. He perseverated on that. He started to shake on his fingers and on his hands more intensely, his lower lips started to twitch, his voice was deep and louder. I know that at that time he has uncontrollable outburst of emotions which does not make him fit to see the succeeding patient. Our next patient was more complex in the CCU, an impella detachment patient with whom a Swan Ganz catheter has recently been discontinued. I have asked him to take a break for a while in order to compose himself, destress and recollect and that he can calm down to have clear thought to continue later on. This suggestion did not make him happy, he raised his voice, continues to be fidgety and refused to take that suggestion. He angrily responded "let's forget about that, let's continue and move forward". I discussed with him the APTA core values and that it is empirical that at this very moment he needs to stop and take a moment. He is just not getting that. At this time, I have to protect the patient that we are about to see. I could not allow a student who does not have clear thought and who is not on the right stable emotion to be around a less stable and more complex patient. I insisted for him to start documenting to calm his nerves down. I have consulted Ms. Candace, our SCCE about the incident and she suggested that she will take the student for the remainder of the week. It is in my understanding that she called you to made you aware.

It appears that that Joe has poor reception to feedback. He does not seem want to be corrected and he is poor with self assessment. I have noticed this when he failed to do his Epic training before reporting to duty which made him delay his computer access while other students already had since day 1. He lacks determination to problem solve this with no initiative on his part. He blamed that on the IT people. He is very keen this time to get his hours during this rotation because he shared that he had some issue with his prior rotation with regards to his unmet hours and he blames his previous CI on that. He even blames the school for not teaching MMT promptly (esp the "+" and "-") and that it was taught on the last minute before rotation. I don't seem to believe that since all other students I had were all good at it. Joe seem to have problem accepting and working on his shortcomings.

Seeking and responding to feedback, accurate communication, as well as assuming responsibility for learning are essential parts of our APTA values. This is essential in honing students in order to establish a caring and solid character of an efficient clinician in the future. I wish I had the chance to show this essential character of our profession to Joe, had he not shown untoward behavior over that stated incident.

It may be helpful for Joe to be assigned on less complex rotations. Assignments that requires a lengthy and close encounter with CI who has fewer case loads may work for him in the future. Perhaps encounters that are less stressful or stimulating may help him define his good points and attitude in the future. Acute setting may seem to be overwhelming for his emotions which he clearly has difficult time of controlling.

Rest assured that I am one amongst you, Dr. McClellan, in molding your students as future physical therapists, clinicians that uphold our professional standards and values in seeking excellence in our practice. Be complacent that I am in accordance in your role of modeling and mentoring professionalism in our profession.

I will continue to remain as one of your pillars in clinical excellence.

Thank you so much.

Sincerely,

Jay P. De Vera, PT, DPT APTA certified clinical instructor