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

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.”


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. 

action item


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.

4Trauma-informed Care Implementation Resource Center. “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.

7Tulshyan R. We Need to Retire the Term Microaggressions.
Harvard Business Review, March 8, 20222,

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:

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:

Jane Oeffner, PT, DPT, MBA and Megan Schaefer, PT, DPT

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 mks365@drexel.edu