Guns N’ Roses’ ‘Welcome to the Jungle’: Teaching Soft Skills in the Clinical Setting
Skills to build stronger and more resilient physical therapists
By Jane Oeffner, PT, DPT, MBA, and Megan Schaefer, PT, DPT
Welcome to the jungle!
Our increasingly VUCA (volatile, uncertain, complex, and ambiguous) healthcare and educational climates present challenges to seasoned and new clinical professionals and faculty alike. And especially to our student clinicians, the clinical world can very much feel like a jungle. As they enter the unknown, they are challenged to decide when they need to camouflage and blend with those around them and when to step forward to demonstrate their acquired skills. This balance of over and undershooting is part of the learning process and expected of the novice clinician. The clinical instructor serves as their student’s jungle guide, keeping them safe and helping them to stay close to the path to achieve their clinical and social-emotional competency. In today’s maze of social media, the Amazon age of instant gratification, texting as the main modal of communication and 6-8 second attention spans as a result 24/7 information, clinical instructors need their own guide on how to ensure students acquire the social-emotional competencies, otherwise known as “soft skills,” required to be an effective clinician.
According to Maini et al, more than ever, “our future medical workforce needs skillsets to manage the personal and emotional challenges of work, uncertainty and change … in order to build personal resilience, provide the best clinical care in a different healthcare ecosystem, innovate for better healthcare systems, and advocate for more vulnerable communities.”2 That is a tall order to fill and can only be accomplished through shared responsibility and contributions of those teaching our students in both the academic and clinical settings. Together, we must be intentional about teaching our students and new professionals how to be effective communicators, active listeners, person-centered, present, flexible, empathetic, compassionate, self-reflective, and patient as well as how to manage the stress of working in healthcare.
Educational programs provide the foundation for social-emotional competency, teaching the concepts of therapeutic alliance, trauma-informed care, social determinants of health, and self-assessment utilizing the APTA Core Values and the Professional Behaviors for the Twenty-first Century (formerly Generic Abilities).3 Programs utilize case studies, standardized patients, role-playing and self-assessment activities to bridge the gap between didactic knowledge and clinical application. While these experiences provide the opportunity for self-reflection, recognition of personal biases, and development of soft skills, students and new professionals will only master such skills through novel scenarios in the clinical “jungle” under the guidance of and coaching by caring, patient teachers.
Rebekah Griffith, PT, DPT, who provides services in the ER at University of Colorado Hospital in Denver and offers consulting to others starting such programs, shares her perspective on teaching history taking so as to quickly ascertain contributing factors related to social determinants of health. She teaches students to ask open-ended questions (tell me about where you live versus how many steps do you have?) and to listen for deeper meaning.
Rebekah shows her students the art of “receiving a history, not taking a history,” connecting human to human. “Part of that is getting the patient settled, receptive and ready to tell their story — you’ve got to stop the engine, before you can fill it with gas.” She finds students are often not ready or prepared to hear and act on what they learn. How do you plan for discharge to the street? Rebekah feels that students and new professionals she mentors are not lacking in knowledge and skill but the ability to pivot and “use their familiar tools in unfamiliar ways.”
TRAUMA-INFORMED CARE LENS
What is a trauma-informed care lens? Being sensitive to the impact of trauma on others and yourself, understanding and utilizing tools to support self and others in regulating during times of stress; as well as identifying and supporting the system change needed to reduce re-traumatization.4 As clinicians, we use this process when working with patients, but do we think about it in terms of teaching our students in the clinic? How a student reacts when encountering an extreme situation for the first time will be informed by their past and therefore may not be appropriate or effective. A prime example is sexual harassment or bullying by a patient for which direct, assertive communication and redirection are the most effective strategies. However, a 2018 study by Cambier et al demonstrated that physical therapists and physical therapist assistants with fewer than 10 years of practice, as well as students, ignore such behaviors which was shown to not be effective in curbing patients’ inappropriate behavior.5 A student who has been sexually harassed in the past may have an entirely different reaction. Just as asking and listening to understand where patients have been helps you guide them to success, so it goes with students.
Joel Stenslie, PT, Partner and Clinic Director of Human Performance and Rehabilitation Centers, Inc., describes his experience with students’ impatience with difficult, slow-progressing cases. He attributes this to our new world of instant gratification and the ability to “ghost” someone you no longer want to deal with. What happened to “when the going gets tough, the tough get going?” Joel shares with his students that “it’s not the easy wins that are the most gratifying, but it is when you change the course for that ‘challenging’ patient,” demonstrating that perseverance pays. He, like Rebekah, emphasizes listening for deeper meaning to truly understand the patient’s challenges, goals, and motivation.
A professional knows the “rules” and follows them but also recognizes that there are “gray areas” and has the skill to make a judgment call for the good of the situation. An example of this nuanced thinking is the clinician who shares a bit more of themselves to foster a connection with a patient. It is knowing a joke will help one patient smile and another patient cringe. It’s taking 10 extra minutes to listen to your patient who is struggling and then switching gears to prevent escalation when you start your next patient’s session late. It’s recognizing that the patient’s perspective is real when it deviates from the objective findings and building trust so the patient will share where they are or have been.
These “soft skills” are often subtle and not easily picked up by the untrained student observer, so we cannot assume students and new professionals will just “get it.” A heightened awareness to these “teachable moments” results in their inclusion in our debriefs. Showing our own vulnerability by sharing times when things went wrong creates an environment for the student where it is safe to make mistakes, learn from those mistakes, and have the opportunity and confidence to try again.
Professional behavioral expectations not only change over time but may vary across clinical environments. Depending on past experience, some students will quickly “read the room” as they begin a new clinical experience and easily acclimate to the culture related to professionalism. This variability may be difficult for more concrete students to observe as they navigate the dense jungle of clinical environments. Clinical educators create expectations and learning experiences to both assess and progress a student’s level of clinical skills and this process is equally critical for the development of “soft skills.” As we onboard students and new clinicians, we routinely orient them to basic policies and procedures, train them on software and the electronic health record, and evaluate clinical competencies, but often assume that professional behavior expectations need no explanation. Being intentional with orientation and professional behavior goal-setting helps lay the groundwork to keep students and new professionals on the right path.
Taking the time to teach soft skills and professionalism purposefully is good for business. Professionalism improves communication among multi-disciplinary teams which in turn lends itself to a culture of safety.8 Professionalism improves patient satisfaction.9 Professionalism can improve employee satisfaction and engagement. Intentionally supporting students and new clinicians as they master the soft skills required to navigate our healthcare jungle will help mitigate missteps, provide guidance across unknown terrain, and contribute to excellence in our future physical therapists and physical therapist assistants.
1Rose A. Welcome to the Jungle. [recorded by A, Rose]. On album Appetite for Destruction.
2Maini A, Y Saravanan, Singh T, Fyfe M. Coaching Skills for Medical Education in a VUCA World. Medical Teacher. 2020;42(11):1308-1309, DOI: 10.1080/0142159X.2020.1788713
3APTA.“Professionalism in Physical Therapy: Core Values Self-Assessment.” Published 2013. https://www.apta.org/contentassets/aec54663ee514f0580449b7ee59ac18c/core-values-self-assessment.pdf
4Trauma-informed Care Implementation Resource Center. “What Is Trauma Informed Care?” https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/
5Cambier Z, Boissonnault JS, Hetzel SJ, Plack MM. “Physical Therapist, Physical Therapist Assistant, and Student Response to Inappropriate Patient Sexual Behavior: Results of a National Survey.” Phys Ther. 2018;98(9):804-814. doi: 10.1093/ptj/pzy067. PMID: 29893928.
6Queens U. Defining Professionalism. https://www.queensu.ca/teachingandlearning/modules/ethics/11_s3_03_defining_professionalism.html
7Tulshyan R. We Need to Retire the Term Microaggressions. Harvard Business Review, March 8, 20222, https://hbr.org/2022/03/we-need-to-retire-the-term-microaggressions
8E, Anderson R, McEvoy MD, Brodman M. Professionalism: A Necessary Ingredient in a Culture of Safety. Jt Comm J Qual Patient Saf. 2011 Oct;37(10):447-55. doi: 10.1016/s1553-7250(11)37057-2. PMID: 22013818.
9Hush JM, Cameron K, Mackey M. “Patient Satisfaction with Musculoskeletal Physical Therapy Care: A Systematic Review.” Phys Ther. 2011 Jan;91(1):25-36. doi: 10.2522/ptj.20100061. Epub 2010 Nov 11. PMID: 21071504.
Jane Oeffner, PT, DPT, MBA, an APTA Private Practice member and Impact editorial board member, is the Director, Strategic Clinical Partnerships at Widener University in Chester, PA. She can be reached at jkoeffner@Widener.edu.
Megan Schaefer, PT, DPT,is a Clinical Professor and Director of Clinical Education at Drexel University, Physical Therapy and Rehabilitation Sciences in Philadelphia, PA. She can be reached at email@example.com