Residency Reflections: Through a Black Box
September 2008 Issue
As an undergraduate Student, I learned about the idea of the "black box"-an unresolved model of a system's function. In modeling, the input is known and the output can be measured, but determining what happened to the input as it passed through the mysterious box involves a good deal of assumption. When I came to Chicago, I knew what I was willing to input, and I was certain of what I wanted the output to be. I was prepared to give my time and effort to focus on a well-rounded training program and to learn from orthotists and various rehabilitation professionals. I came to the Rehabilitation Institute of Chicago (RIC) to come out as a capable practitioner. Along the way, when I saw that my inputs were not giving the expected results, there were many times that I revised my outlook.
Not having had a professional job before, I came to the RIC assuming I would enter a system where hard work and knowledge of P&O were paramount. I had no understanding that the building I would come to every day would have challenges that had nothing to do with orthotics. Transferring clinical knowledge to patient outcomes required the ability to interact effectively with patients, co-workers, management, and adjunct staff. Moreover, paperwork, workflow, computer systems, and ordering all had to be mastered before I could be an effective clinician. This learning curve may vary with every facility but should never be an impediment to good patient care.
Applying My Knowledge Base
At the start of my residency, I thought I would need to significantly expand on my knowledge base to be able to treat my patients. On the contrary, my schooling in anatomy, gait analysis, biomechanics, fabrication techniques, and clinical pathology provided a sufficient foundation. Though there were instances when I was required to learn more, usually my efforts involved refining my skills and becoming more efficient. At work, production goals sometimes superseded self-growth. However, by continuously resolving the black box and reworking my model, I was able to challenge myself to get better output from similar inputs. It was frustrating to think that each subsequent patient was receiving better treatment than the previous one, but necessary personal growth comes from repetition and a deeper understanding of your mechanism. Still, I found that not everything should be so cerebral and mechanical.
Getting to Know My Patients
To find optimal solutions for my patients, I approached them with a level of professionalism and objectivity. I achieved good results, and I produced well-fitting orthoses; however, there was a lack of personal connection on my part. I came to Chicago wearing a layer of armor to protect myself from the people I was treating. I stayed impartial so that I could stay focused and find resolutions to the problems at hand. Soon I realized that if I only used my hands as the means to transform my ideas to an orthosis, something was missing. Without involving myself in my patient's care, there was neither potential for sacrifice nor benefit. For that initial period, I lost the great advantage of working with people by focusing only on the device. In time, I found that occasionally the greatest support you can give to your patients is just listening and encouraging them to move forward. During a residency, making personal connections with your patients can be difficult. A year is a short period of time to see the progression of a patient. Many times you will just be shadowing, but as long as you stay engaged, there will be patients that you will inspire and vice versa.
As I passed through RIC this past year, I made many professional and personal resolutions. As with any aspect of my life, the understanding of who I am and how I function became less obscure as I repeatedly tested my system. I know that I enjoy helping others improve their physical function; moreover, my fascination with biomechanics persists. Interacting with a variety of people, especially my co-workers, has been an added bonus.
So, what does the long-term future hold? Given the amount of modifications I have made to my black box, who can say? The only constant will be change. I know I will continue to build on the education and experiences I have enjoyed over the last three years. As for right now, my professional life will continue at a large publicly traded company (can you guess which one?) near my home in Los Angeles.
Ronald A. Roizhas shared his experiences with The O&P EDGE as he completed his residency at the Rehabilitation Institute of Chicago (RIC), Illinois. He is a graduate oftheMSPO Program at the School of Applied Physiology at the Georgia Institute of Technology Atlanta.