2025 E1 - Induction

[MUSIC] Good morning and welcome to the Art and Science of Physio. My name is Jeremy Hopps, joining me as always is Jane Schomburg. How are you, James? >> Good, thanks, Jeremy. >> Great. So we're APA titled Musculoskeletal Physiotherapists. We're based in Australia. We also lead the second visit, and second visit's a training and mentoring company that helps practices be the practice of choice for physios. And the physios be the physios of choice for practices. So we're really looking forward to bringing you regular content where we unpack how you can thrive and how your business can thrive in private practice. And private practice is built different. There are specific challenges and specific nuances that are unique, and often unable to be taught in detail through uni. So each episode we're going to discuss a heart or current topic in the physio or allied healthcare world. And we'll interview well respected thought leaders in our industry. And so today we're going to be talking about induction. So we begin to fall back into the routine of 2025. New staff are being on boarded, many of which are new grads or maybe they're new to private practice in Australia. And our new staff want to thrive, they want to learn, they don't want to burn out. They want to become effective and deliver great outcomes. And ultimately they want to earn a decent living in their chosen career. And for owners, you guys want to ensure your new team member is supported to grow and flourish into a confident and productive practitioner. So they can be rewarded and the business remains profitable and sustainable. So James, I'm keen to hear from you about why you think it's important that owners have a structured and intentional induction program for new staff. >> I think it's probably one of the most critical things. In my years that I've run a practice, which is 25 years, I realized very quickly that how you start often determines the pathway they're after. And so you really need your team to be absolutely understanding of their role, the culture of your practice, your expectations, the clinical philosophy of the practice. And all that happens, it can happen just organically, but it's very rarely effective, far more effective, I think, is to actually have a very structured program to initiate your new team members, particularly as you said, those new graduates, or those particularly also from overseas, or haven't worked in private practice to understand the nuances of private practice, and to understand your expectations, and also for you as the employer to understand their expectations as well. >> Yeah, great. So yeah, I would agree that in my experience too, making sure you've got some kind of structured program at the front end, yeah, so critical in determining the course of a physio's career and journey, and we want to retain good people. And I think if you can train them well, that goes a long way to helping retain them. Yeah, for sure. What are some critical elements, James? What are some key things that go into an induction program that you think that help that process move forward and be successful? >> Well, you need the structure, as you said. It needs to be very, very well thought out, prepared and planned and advanced. The key with all good programs is that. And it's really interesting when I look back. When I had my practices, we created our own programs, and I'll share with you what some of the key ingredients, I think, were. And we made sure that this program was done consistently. So we had weekly induction sessions, which were really training sessions on specific topics. And that program was 12 months in length. And it was intuitive for us. But really, what was very good news that we were doing the right thing was the evidence. When I created this, and I know you did something almost identical, Jeremy, there was no evidence. It's just what we thought was the right thing to do, which is what you always go back to when you don't have any evidence. But two, three years ago, some really good work by Lucy Chipchase and Kerry Evans and other authors, but they were the main two, showed really that a structured program, at least nine months in length, yields far better results for resilience and also for the happiness of the staff and also for them to be retained. So that's the first thing. It needs to be done over a long period of time. And I think from the research again, it showed that there's that rocky road about six to nine months where you suddenly realize what you don't know. And I think it hits you again. And that's a time where a lot of new graduates and young people just starting are quite vulnerable. And that's why you want to continue it well beyond just the short term. I've seen a lot of practices do often really good inductions, but they're really short six weeks, three months. And that's still important. But unfortunately, you're going to find at this front end, they're just taking it all in your grades. Everything is new. Everything's a bit of a overwhelm for them. Whereas by six to nine months, those messages can be assimilated a bit more. The reticular formation isn't just focused on what's the next question after asking the subjective. There are but to put things together. And I think that's why it should be spread out. Yeah, I reckon from my perspective, some of the like, I often say to for new graduates, it's a bit like drinking water out of a fire hydrant, right, isn't it? When they start, there's just so much information coming at them. And they, you know, they're wanting to be able to how do I treat the knee best? How do I treat the shoulder, the lumbar spine? But there's some other skills that I think can yield some great results for them early and help them, you know, that that clinical stuff will come and it will come with time and with more learning. But what do you think are some of the critical topics in that early induction program that will help them move forward? So some of the like, you know, for example, I would often teach some of the grads about just how to deliver a great first consult. Like, what are some of the critical elements of delivering a great first consult? But what kind of topics would you pick in an induction program that would be most successful? I think a bit of the heart and the head at the same time. So I think the heart, I'd be talking about burnout. Yeah, we know that it's a topic that's increasingly an issue and research bears it out too. So helping them understand burnout, helping them understand how to use their time wisely. Because a lot of them just, you know, I had a chat this week with a new grad who's starting in a practice. I do some consultancy and, you know, he said, where do I start? What do I read? And, you know, what you said, the phyhydrinology is exactly what he was describing. And, you know, letting him know things like that, because that does create burnout. I said to him, you can't read everything. No, you know, so giving him real clear guidelines on what to read. And you're on that, I recommend often, you know, wait till you see a client. That's one of the key things I said to them. Can't read everything. So see a client. Yes, there'll be lots of new things you'll see. And between that first visit and that second visit, that's when you sort of weigh and study on those things that you're unsure of. And that's why we call it the second visit, because it's between the first and the second visit that really makes all the difference. So I would always encourage, as I did with this young guy, is see a condition. If it's something you haven't seen, let's say it's a tennis elbow. And we never seen a tennis elbow in placement. And he hadn't, and when I said tennis elbow, you could see the fear in his eyes. He said, what happens if it is my first patient? I said, you'll be able to find something to do. You'll be able to treat them. And if you show care, warmth, and empathy, you'll probably get to a second visit. But it's between that first and second visit, speak to your mentors and go and look at guidelines. And if I come back to what I'd say, prevent burnout by not trying to read every RCT, which a lot of people do, go straight to tennis elbow, clinical practice guidelines, Google it. You'll come up with the most recent article. And they're nearly always free, freely available when they're clinical practice guidelines and use that as a framework, but also use your peers. I think a lot of these physios have to remember, too, that the clinical outcomes will continue to improve as they get better. But some of the time, that's not the reason necessarily a patient will come back, is it? Like day one, I mean, that first visit, it's the connection. It's the therapeutic alliance. It's the communication. It's doing those things that they can instinctively do really well to get that opportunity to do the research and get the patient back for the second visit, where they can continue to work on their clinical outcomes. And I think there are some of the topics I think are really critical, aren't they, is kind of how to communicate well, how to build therapeutic alliance, what is clinical excellence. The course master in clinical excellence kind of touches on those things. Yeah, there's that kind of understanding that some of those soft skills of how to actually speak well to a patient, how to rebook them again, how to, you know, those things are going to be an easy win for these young physios, aren't they? Absolutely, and you're right. There are skills that, you know, that you can get better at as you go along. And you realise, you know, how to improve the way you say things. But just genuinely, genuinely actively listening and genuinely letting the person tell their story. And generally being interested in the person is going to get you a second chance. Understanding their expectation too, isn't it? Absolutely, yeah. So that's probably one of the critical ones. The other one for me, which I see consistently that I like to talk about is appropriate treatment frequency. Yeah, as you know, we both run workshops on this because it's a common mistake that I see a lot of young clinicians do is they under treat. Yeah, and it's because they have got so many, I haven't got a frame of reference, they're not taught it. So I think as a practitioner, you should be telling them how often is it appropriate to be treating a nerve rate versus a chronic person with persistent pain in the knee with NEOA? You know, they're going to have different frequency, they're going to have different time frames and going through and giving them some general rules to actually use to actually choose appropriate treatment frequency. And that to me is critical and certainly early on in their care, ensuring they don't under treat, which as I said, is a common thing. Yeah, absolutely. What about clinical reasoning, James? We know that that's a process and I did a number of reading on the readiness of new graduates for private practice as part of some training that I did the last few years. And one thing that kind of came out really strongly in that reading was that the things like clinical reasoning or a lifelong pursuit, like it, you don't graduate and are an expert at clinical reasoning, right? That's the whole whole thing about reasoning. It takes time and it takes to develop. And I know a lot of graduates when I speak to them, whether it be through the mentoring programs that we do or even in my own practice, is they kind of say, sometimes I want to I want to plug my brain into yours and download what you know, which is obviously is, you know, not not possible, but the the importance of the matrix. In terms of the importance of clinical reasoning in our induction programs, number one, we would both agree that it's really critical that we involve clinical reasoning in our induction programs. But in terms of how would you go about in an induction program with a with a, if you were an owner, how would you sort of structure and how would you go about helping a graduate improve their clinical reasoning? I think, again, I come back to the research and what we did before is now being picked up with the research is regular case reviews, so I in the practices we work with, you know, you and I work with where we can, when they are keen to adopt the full model, which has got a really strong evidence base. It's a it's regular case reviews, because that's where you pick up errors and reasoning or just their their mode of thinking, which is often different to mine, and it's often excellent, too. It's just different. It's a different way, because there is, you know, there is there are plenty of correct ways. There's not one way always for a lot of your thoughts and beliefs and your and and yours, what have you, based on what you found, what have you done? But case reviews really tease out people's beliefs and we encourage them to be mixed. That is, you know, always look at one key thing that should never be mixed is look at current cases, don't look at cases that have been burnt, you know, patients that have already discharged. I think are fairly and the research supports, they're not as valid, because if you want to go through a case that you've the person's already checked out on, the learning is going to be very limited because you can't go back and apply what you've learned from that session. Whereas if you're seeing a client, you then do your case review. They're going to be armed with a whole lot of things that perhaps I thought of in terms of clinical patterns, in terms of questions that they needed to ask and contributing factors, all of these things which add up to the clinical reasoning process. And then they can test those hypotheses out and come back and reflect. And that's where it's really valuable and I encourage early on care because early on you see them with if you see them with them. If you do the review, does it one visit two or after visit three, there's a chance to change direction should the direction need to be changed or chance to even just to tweak it. And so I think there's real opportunity with randomness, not actually picking always a client that they want you to go through. But also there's also value in that too. So what we do is mix it up. And that's what I encourage practice owners to do. Bring a case pick a case randomly that just started seeing and you'll pick up some pretty interesting things. But also every alternate session, let the clinician come with a case that they're stuck with because they always want to have those questions too. And so they tend to be more complicated. They tend to be more later on care. Why is this person not responding? And you get a different set of learning from that as well. But there's a tendency to I think look at the two areas I see is just failing, just focusing on failed clients already that I think that's redundant. And the second one is always dealing with complex cases that the physio chooses because often if they had been picked up some of those areas early on, they may not have become complicated in the first place. Yeah, that's really great advice. There's certainly there's so much to unpack in clinical reasoning, isn't there? It's a huge topic. And I know one of my favorite tools which I've been using more recently is asking our graduates to complete a very simple clinical reasoning form. And I know they've done lots of this at Uni most of them don't want to be doing lots of it. And I certainly don't ask them to do it every time because they just sick and tired of it. But every again, like if you're reflecting on a client and you've done your case review, it can be a really, really nice exercise as they kind of step through. I've got a one pager that I tend to use. It's a WA1, the Musculoskeletal Clinical Translation Framework. It's a lovely document that looks at a range of things. And I guess as they kind of understand it, like what I'm trying to help them do is think that way, think about all these elements of a person, which can be really useful. So while they might hate completing it early, it does add some significant value to them after a number of weeks or months of doing it. And if they're only doing one a week or one a fortnight, that's fine. But it's just another way of improving it, certainly improves my reasoning. That's true. I like that the framework is something that I've used a lot. And I think send it with students, post grades and under grades. But I think using it with your own staff is a fantastic tool and it's aged incredibly well too. It's not a new document by any means, but clinical reasoning is clinical reasoning. Correct. Yeah. And I like what you said, because it is a burden if it's done with every client. But if they did it once every week or once every fortnight, depending on their need and need and their want, they'll get so much out of it. Particularly if it's then brought back to a peer or a mentor who can go through their thoughts. It's useful as a self-learning strategy, reflection, that's the word, but I actually think even better would be sharing it. And you can do this in so many forums, you could do it with your mentor, or you could actually do it if you've got people in your same year. You will have gaps and using those saying, OK, let's go through my case, or I'll go through your case and we'll work together. You'll learn as much from other people as you will from your own cases. Yeah, fantastic. And I think the other thing that's really helpful is we kind of finish up and close off is recording of consults. One of the things that was so helpful for me over the last number of years, and I've been a physio 26 years, but to record a consult with consent, of course. It was a video consult and then pass that to a peer or a mentor or someone above you and work through it together in terms of the things that you can improve upon in your subjectivity. Examination. Why did I think that way? What made me do that test? And again, as intimidating as that sounds, and I can tell you it's very intimidating to start with, the learning is astronomically off the charts. You know, great. Yeah, it's a it's a phenomenal tool to you. It is. I agree. It is. Look, it is probably the most confronting form of learning. We both know that from our studies and from and I think it's and having been on the other side, watching them, I can see how much it can change. Sometimes how tough it is, but you're right. It really does bring up a lot of things that you you miss. And the other thing too is even just the final one I'd say on this is don't be afraid to get somebody in there, particularly a mentor. Occasionally to look at you treating in the room, because not just recording, because it's a they will pick up things. Sorry, the recording that come back to your recording of it, too, is if you listen back to it yourself, you realize sometimes, did I say that? Is that how I said it? Gee, I was leading them on that way. You know, if you're somebody who does a lot of opening open questions or somebody you think does a lot of questions, you might get surprised by how often you ask. Yeah, those questions and or cut people off, those sort of things. So even just simply recording it, I think can be invaluable and that may be less threatening than having a peer or even more important a mentor sit in. But I think all of those are great options to consider. Yeah, excellent. Well, thanks, James. It was a great first podcast as we discuss things induction and for all of you guys listening, we thank you for joining us. I hope there's some tips and tricks that you've got out of this particular podcast. We're going to try to come to you reasonably regularly with this podcast so that we can discuss all things physio and the art and science because we know that evidence based practice is really, really helpful for us. But there's so much in physio that that doesn't have strong evidence and we need to be able to go. How do we make a decision in that space and hopefully we can bring you great content that helps you with that in your practice and day to day life as a physio. So thanks again, James. It's great to chat with you as always and we'll catch you on the next episode. Thanks, Jeremy. I think that'd be a great topic actually talking about evidence based practice and, you know, how do you actually how does the art and science of that work? I think that's something that you and I are both passionate about. Yeah, maybe that maybe that's a week to a session two. Hey, thanks very much, Jeremy. No problem at all. Until next time, have a great week in practice. [MUSIC]