Physical therapy, occupational therapy students partner for free clinic

Physical therapy students from East Carolina University’s College of Allied Health Sciences have been at the helm of a free, student-run clinic for several years, delivering quality health care to eastern North Carolinians who would otherwise lack treatments that would help them regain function of their bodies after setbacks caused by illness or injury.

A new partnership with fellow College of Allied Health Sciences students from the Department of Occupational Therapy will further enrich the quality of care provided to patients at the student-run clinic, with an increased focus on rebuilding whole-of-life capabilities like returning to work, adapting to new physical limitations or simply getting dressed.

The student-run clinic is free for patients, which is a key part of the ethos of the College of Allied Health Sciences — for students to be of service to the community while enrolled at ECU, which helps to instill a sense of commitment to give back once graduates are in the workforce.

Physical therapy student Ashley King works with a patient during the clinic.

Physical therapy student Ashley King works with a patient during the clinic.

“Our mission is to bridge the gap between quality rehab services and people who are under- or uninsured,” said Logan Leggett, an occupational therapy student from Hazlehurst, Georgia. “So, we offer pro bono services through this clinic. We’re able to get clinical experience, that interprofessional education piece, and we’re also able to increase access and work on addressing health disparities in the community in a very tangible way.”

Leggett said that many of the clinic’s patients are referrals from ECU Health who are often discharged after treatment after experiencing a stroke, for instance, but have no access to occupational therapy once they leave. An inability for patients to have for-fee occupational therapy, due to a lack of private insurance or having exhausted their allotted OT visits covered by insurance, often results in referrals from health care providers at the time of discharge.

“The fact that we’re getting referrals from doctors, orthopedic surgeons, they wouldn’t refer their patients to us if they didn’t think their patients would get better with our care,” said Heather Hubeli, a third-year physical therapy doctoral student.

The student-run clinic sees 20-25 patients a week over two days of sessions, which are overseen by faculty from the physical and occupational therapy departments. Patients meet with students for an intake evaluation and then collaborate with students on an individual care plan, as would occur in an outpatient therapy setting, but with the added oversight by faculty members.

“We try to prioritize patients who don’t have insurance, who have been getting PT at another place and only get a certain number of visits, and we also see patients who have Medicare or Medicaid,” Hubeli said, explaining the focus on expanding access to services offered by the clinic.

As part of a similar initiative, Hubeli and follow physical therapy students have partnered with medical students from the Brody School of Medicine who run a similar pro bono clinic and refer their patients who need physical therapy to the student-run PT clinic.

Unequal access to health care isn’t just about being able to pay for a doctor’s visit, Hubeli said.

“Our biggest barrier right now is transportation. There is a whole group of people the med students see as part of their medical outreach who need physical therapy. A lot of their patients just can’t get to our clinic,” Hubeli said.

The physical therapy students who have been involved in the clinic for several years agree that incorporating the occupational therapy students into direct patient care takes the ideas of interprofessional collaboration learned in the classroom from theory and to hands-on, interprofessional practice.

“It’s good to see the excitement that the students have in seeing real patients and to feel the energy from the OT students,” said Dr. Denise Donica, chair of the Department of Occupational Therapy. “It’s also been really exciting to hear them communicate and collaborate with the PT students leading up to today.”

The clinic is free for patients, which is a key part of the College of Allied Health Sciences' mission of service to the community.

The clinic is free for patients, which is a key part of the College of Allied Health Sciences’ mission of service to the community.

The clinic is specifically labeled as student run because senior students are in charge of planning and executing the programmatic administration of the clinic as well as the day-to-day management of patient scheduling and hands-on patient care.

For this semester, Donica said, only two occupational therapy students were involved in treating patients in the clinic, but they met with their physical therapy peers to map out treatment plans for referrals who were existing patients that PT students had seen over the course of time. Four additional occupational therapy students have been involved in the development and administration of the clinic.

“It’s definitely been a little chaotic with less space and a lot of people figuring out what’s going on, but it’s really cool because all of the patients they are seeing in OT are being seen by student PTs,” Hubeli said.

The collaboration is as much about dispelling stereotypes that the PT and OT students might have about the other specialty as it is engaging patients with physical and occupational therapy.

“We used to perceive OT as the ‘hand therapists’ because they know the hand better but that’s just not the case,” said Natalie Bryie, a third-year physical therapy student from Indianapolis. “As PT we think of diagnoses. We see patients after a rotator cuff tear or a stroke and our goal is to treat their impairments, but OT thinks about how those impairments affect other aspects of life, what is it that they can help you do better, whether it’s a job or an activity.”

“We are the muscle movement people at the end of the day, but we also want to treat our patients holistically and think of every person as a person and not just as shoulder pain. I think working with the OT students will help us better achieve this goal,” Bryie said.

Bryie used a newly diagnosed diabetic patient as an example of how the PT and OT students are working together to achieve a comprehensive approach to patient care. That person may be experiencing falls due to neuropathy or strength deficits that can affect balance and overall quality of life. But that same patient may not improve with physical therapy if they don’t understand how to take necessary medications and balance meals, which for many could be a huge lifestyle change.

One lesson that the students admit to learning through experience and that their instructors see as key to both PT and OT students maturing in their understanding of how to deliver quality health care is to see the whole person, not just the physical ailment or life-skills hindrance.

“As a student, you don’t usually see the community, really, you see the college campus and your apartment complex,” rather than the homelife and day-to-day challenges of patients who benefit from the services of the pro bono clinic, Donica said. “It is beneficial for them to be able to see that through their own eyes and see again how the knowledge they have can help improve somebody else’s life.”

For the occupational therapy students, this clinic is an opportunity to complete one of their internship requirements for graduation, but also to work on leadership skills and learn how to manage a clinic, a skill that Donica said is hard to replicate in the classroom

“A lot of times, as a student, you don’t get access to the management roles. The leadership team really gets to develop these skills in action so they can tell employers ‘I helped lead a clinic,’” Donica said.

The student-run clinic is, in some ways like a set of training wheels, in that students can experience all the complexities of a clinical setting without the pressure to meet timelines dictated by business pressures, Donica said.

Hubeli and Bryie take pride in caring for patients as they would once they graduate and are part of the healthcare workforce.

“When we go out on our clinicals we’re paired with a clinical instructor and you’re with them pretty much all the time. They’re right over your shoulder for the most part,” Hubeli said. “And here you get a little more freedom. Our faculty members are there and engaged but we get to lead the session and they’re not perched on our shoulder the whole time. We get to make decisions and feel confident in ourselves. It’s just a huge confidence booster.”