Gowtham Pidaparthi
Gowtham Pidaparthi
Reg. Physiotherapist, MCAP, RCIC
Reg. Canadian Immigration Consultant
5+ years real time experience in running own clinic in Canada, coached, mentored and many more …

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Subjective Assessment Scenarios:
There might be different challenges with Subjective scenarios.
1. Patient not co-operative
2. Patient misleading with symptoms
3. Patient asking about their treatment while you are still taking their subjective history
4. Patient jumping into different areas of subjective history
5. Patient not fit for Physio and your job is to find out potential red flags and refer to GP

Case 1: patient not co-operative. There could be various reasons for not being co-operative and you need to find a way to convince them and draw information from them. Do not get angry at them or do not shout at them.

Case 2: patient misleading with symptoms. Some times patient keeps telling what he wants you to hear but you need to get the full picture of his condition to come to the right conclusion. Just because you got some positive points leading towards a diagnosis should not make u jump towards a diagnosis. You should rather complete all areas of the assessment thorughly and then you may come to a different conclusion at the end.

Case 3: patient asking about treatment during subjective

If a patient keeps asking about his treamtent. Show concern for him but politely tell the patient that you would be able to guide the patient better if you have complete knowledge of his/her symptoms before u give suggestions on treatment.

Case 4: patient jumping into different areas

This is quite common as what may be important for you may not be so important for the patient. So as you are taking the details of aggravating factors the patient might talk about his goals or social history or something else. You need to politely tell the patient that you shall address their concerns but you would like to ask questions in an order so that you would not miss important information required to inderstand patient's condition. You shall appreciate them for understanding the importance of being organized in formulating questions.

Case 5: unfit patient or red flag patient

This is the most important of all scenarios as it questions your ability to identify red flags and refer them to their GP for further investigations. If you decide to treat this patient it becomes an issue as there is chance of the condition getting worse with Physio or chance of delay in diagnosis of life threatening conditions.

One recommendation would be to have an acronym for subjective history and also prepare for Subjective Ortho, Neuro and Cardio-resp questions.

One common error is not asking follow up questions

For eg. I have seen students ask do you have diabetes? Patient answers "yes". Candidate replies "perfect" or "very good" or "good" and then asks the next question do you have Hyper tension and the patient answers "yes". The candidate again says "perfect" or "very good" or "good" and proceeds with the next question. What is so "perfect" or "very good" or "good" in having Diabetes or Hypertension. "Ok" is an acceptable term to use. Do not say "sorry" for that. It is not required to apologize for his medical conditions. Say OK and ask follow up questions like how long have you been Diabetic? Is your Diabetes under control with medications? What medications do you take?
Ask open ended questions. Do not ask is you pain dull or sharp? Instead ask patient to describe their pain sensation. Do not ask leading questions. If a question is answered "yes" always there should be a follow up question. Meaning the patient/model has more information to share about that particular area.

Hope you all improve on your subjective examination skills and perform well not only in the exam but also in real life practice as Registered Physios.

All the best!

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1 month ago

Self Limiting Beliefs for international Physios

1. "I can not communicate well or my English is poor" I have a very good friend whose English is not the greatest but he passed 13 stations on his first attempt in clinical exam. So if u are able to clear IELTS or TOEFL u have more than required English to communicate with your patients or succeed an exam.

2. "Canadian Physios have better knowledge than international Physios". Absolutely wrong. You have to remember that International Physios Bachelor degree is 4 years and Masters is 2 years where as in Canada it is 2 years of Masters. International Physios mostly have at least one year or several years of experience dealing with patients where as Canadian grads taking the exam are mostly having no experience after their graduation or less than 6 months experience as resident Physio.

3. "Canadian exam is tough". Any exam is tough if u are not prepared for it. It is not tougher than US or Australia in my opinion provided u know what Alliance is looking for. This exam is to test basic competence to enter Canadian practice. Now there are so many awesome people guiding to clear the exam.

4. "I do not have the resources to practice or prepare". Networking is the key to overcome these issues. If u are shy or staying in a bubble it is hard to get help. No one will knock your door and offer help. Everyone is busy with their life. If you reach out to fellow Physios sailing in the same boat or who succeded I am sure most of them would gladly help.

5. "I do not have Canadian Experience". No one coming from other countries would have Canadian Experience. One good way of knowing or gaining Canadian experience is volunteering in hospitals/clinics or Shadowing a good Canadian Physio practicing in your vicinity. If a Physio offers to let u shawdow he must be academically good. Do not try and learn fancy advanced techniques but learn the way they communicate and assess.

6. "Written PEP questions are tough". Yes, again if u do not prepare well it would be tough. They are very basic questions and if u do your homework answering these questions shall actually help u pass the whole exam as they contribute to 25 percent of the total score and no one can take that from u if u know the answer.

7. "I am too nervous". Exams are generally nervous for most of us. But if u practice properly and be well rested before the exam and follow the general guidelines u shall be fine. This exam is time bound and I highly recommend to practice with timers and video to over come this issue. Some degree of nervousness is ok and expected.

8. "I do not have enough time to prepare". This is a common problem most of us have. Even though u have more than year you only shall prepare in the last couple of months. If u have base knowledge and strong foundations you do not need more than 100 hours to prepare for this exam. If u do not have strong basics then u may need more time to prepare.

The list goes on.... if you have or know any self limiting beliefs post below! The senior group memberd and I shall try and answer.


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