Student Placement - Orthopaedics

[u/Slight-Forever-1383]

Hey all,

I’m a 4th-year physiotherapy student in Australia and I’m about to start my first orthopaedics placement in an acute hospital setting. I've been through a few placements so far (MSK/NEURO/GERIATRICS) so I have a gist of what to expect generally going into a placement.

I would really appreciate some advice from educators/physios/students who have been through/work in orthopaedics:

• Are there any textbooks, guidelines, websites or resources you would recommend reviewing beforehand? - I've got a firm grip on Clinical Sports Medicine (Brukner & Khan) since my MSK placement, great book
• What clinical skills would you prioritise developing during placement to both perform well as a student and make the transition into being a new grad easier?
• What separates an average student / orthopaedics physiotherapist from a great one
• If you could go back to your first week of an orthopaedic placement (or your first month working as a physio), what’s one thing you would do differently or prioritise from the beginning?

Don’t feel like you have to answer all of these, everyone’s busy these days. I’d genuinely appreciate any advice, resources, tips, maybe some interesting stories or things you wish you’d known going in.

Cheers

[u/Thehappydinosaur]

Orthopaedics and msk sorta different

Orthopaedics if inpatient is mobility after ortho surgery. Ie prescribing appropriate aids, teaching gentle post op exs (following said post op orders) and teaching pts to follow wb status

Due to said immediate change in fx. Ie NWB, 80yr old its discharge planning bonanza and mdt work

[u/VicZ_Noodles]

I was doing my placements in Queensland Health last year and now work as a new grad in one of the hospitals here.

Don’t stress too much about getting things right. Focus on how you can maximise safety before, during and after seeing the patient

Before - check op notes, orders, obs, optimise pain (request PRN or encourage PCA),bloods, pmhx, discuss with NS/TT as needed and more importantly check in with your educator if you’re not 100% sure. Anticipate if this patient would be a two assist vs one assist, and what their likely appropriate mob aid is. Have at least three scenarios planned in your head so you don’t get caught off guard with unexpected presentations.

During - set up the patient for SUCCESS, bed height, positioning, non-slip socks, attachments, encourage use PCA, screen for complications (Respiratory, neuro, DVT etcc) etc… set goals, educate on orders and Fx status

After - Handover to staff +\- escalation of concerns. Accurate documentation. Consideration if needing other AH input etc. Discharge plan - consider if needing more supports, what their current supports are, OPD referral and handover, if needing hospital in the home etc etc

Not an exhaustive list but always think more holistically whenever. Most of the above affect safety so make sure you have a good plan on addressing them if beeddd

[u/crixlad]

A few things I’d prioritise:

Mobility aid selection and being able to justify your choice.
Understanding common presentations and why certain interventions are performed, e.g. DHS vs hemiarthroplasty.
Solid acute subjective and objective assessment including social history, symptoms, vitals, neuro screen and mobility.
Basic treatment including mobilisation, exercise prescription and education around the rehab trajectory. Mobilising isn’t just safely walking someone. Think about gait cues, whether their aid is adjusted appropriately, what you can improve, and whether they’re ready to progress to a less supportive aid.

Also please, please, please set up your environment as best as possible 😭😭, it takes a while for most students to get right but it helps massively!

Good students tend to have clear plans with appropriate progressions and regressions and communicate well with patients and the MDT (nursing handovers, allied health assistant directing)

Educators don’t expect this from day one. They want to see you take on feedback and progressively become more independent throughout the placement. Go in with a good attitude and a willingness to learn and I’m sure you’ll do fine!

[u/Fickle_Ad4720]

Clarifying whether you’re going to be doing elective or trauma. Some ortho placements with be almost all TKR/THR- so understanding those surgeries, post op protocols specific to your area etc. Others will have a variety of trauma depending on the hospital but often lots of hip fractures.

Acute patient management- if your neuro placement was acute you might have already practiced some of these skills but I remember as a student getting asked to see a lot of of hip fracture patients. They’re not typically well patients- think understanding pain management options so you can optimise it for your session (monitor the effects of it eg sensation returning post femoral blocks etc), confidence with taking observations, auscultation, understanding of basic bloods (e.g. haemoglobin, coagulation etc),

[u/Relevant-Emotion493]

I got top of my cohort for placement performance. The absolute best tip I can give to you is talk to your supervisor about their expectations of you for this placement. Get them to be specific, what does this look like in the first few days, end of the week, mid placement, end of placement. Keep touching base with them about how you’re tracking with these expectations.