Job Crawling Advice (Round 1)

So I have been hitting the job market for the past 10 weeks or so and it has been filled with (mis)adventures.  While I feel my program actually prepared me pretty well in looking for a job (i.e. we had a couple of classes about writing a resume, what to do at the interview, negotiating job offers, etc.), I definitely have a lot to learn when it comes to putting it into practice.  I am passing on my advice so 1) I can look back five or ten years down the road and laugh about how much I still didn’t know and 2) perhaps save a fellow speech-language pathologist graduate looking for a job some head-against-wall banging.

This first installment focuses on resumes.

1. Get as many people as possible to read over your resume.  This includes your friends, your family, your professors, and hell, anyone you may happen to know who works in human resources.  Get as much feedback as you can.
2. Include contact information, objective, educational history, employment history, honors, professional organizations, and honors.
3. Use an objective specific to the job you are applying for.
4. Use action words.
5. In fact, go check out the ASHA website.
6. When describing responsibilities under your experience section, try to highlight things that make you unique.
7. Don’t make the resume crowded.  Be as succinct as possible.
8. Include the titles of the people you are using for professional references.

Questions?

Public Service Announcement

NOTICE TO THE PUBLIC

It is perfectly ACCEPTABLE and NORMAL to politely interrupt certain hospital staff (i.e. nurses) to impart information about a particular patient.

This can be done in the following situations:

1. When the nurse is in the room of another patient
2. When the nurse is in the room of another patient and in the middle of doing something
3. When the nurse is in the middle of going from point A to point B to accomplish something

The only time you CANNOT under ANY NON-LIFE THREATENING circumstances interrupt the nurse is while s/he is handling medications.

Standing around waiting for the nurse to complete tasks is UNACCEPTABLE and ABNORMAL behavior because it slows you down.

Any overwhelming anxiety you feel about being perceived as rude for interrupting someone in the middle of completing a task because you were raised by a Southern mama (or any mama capable of instilling the Fear of God as regards Rudeness) should be IGNORED and DISPOSED OF.  This paralyzing desire to be Polite will instead make you appear as though you are a completely unassertive failure.

Interrupting nurses is ACCEPTABLE and ENCOURAGED under circumstances outlined above.  NO ATTEMPT to be Polite should be made.

You may now return to your regularly scheduled blog surfing.

Epiphany

When reporting to doctors the results of a swallow evaluation, just tell them what you put in your ‘A’ section.  (Or a condensed version of your ‘A’ section if it is particularly long.)  It covers all the major, important points.  E.g. The patient had no s/s (signs and symptoms) of  aspiration for any consistency and is cleared for XXXX diet.  OR, The patient IS aspirating thin liquids and is cleared for XXXX diet.

So glad it’s only seven weeks in and I’m finally putting it all together.  Augh.

Braaaaains

Have I mentioned I love the brain?  Because I love the brain.  Love it in a way that probably disturbs other people who don’t love the brain.  More accurately, I love cognition, an important part of which is understanding the neuroanatomy of the brain.  That’s why I love aphasia and cognitive-linguistic disorders:  because they involve the brain.  (Reason #639 why I SLP.)

Some exciting developments in the past 48 hours that relate to my love of the brain:

1. I have a case presentation topic and it has to do with aphasia!  (I thought for sure it would be swallowing because, well, we do a lot of swallowing.)
2. I got to spend a wonderful half an hour with a fabulously generous-with-his-time neurologist who gave me a crash course in reading the brain MRIs and also some tips on how to navigate the program that stores the images on the computer here.
3. I saw Awesome Neurologist again while waiting for my ride home and he offered to take me down to radioneurology to learn more about brain imaging and that they all love to teach about the brain.  I told him I would absolutely take him up on that offer.

The reason why the dogs are barking in your neighborhood?  Is because of the high-pitched squealing noise I keep making.  I have got to make sure I hunt Awesome Neurologist down to follow-up on this.

I lucked into this.  (I am feeling very lucky right now.)  For those of you interested in the brain, I highly encourage you to hunt down your nearest neurologist or radioneurologist or your own SLP if they are knowledgeable about it (brains and MRIs aren’t my CIs thing) and ask if they can find some time to show you the ropes with MRIs.  So.  Awesome.

Confession

I try to cover both my ups and downs while externing here (see:  me dropping papers down the stairs and on to patients’ heads; running into doors; writing bad ‘A’ sections; grabbing the wrong jello and never living it down; etc.).  It’s just the truth of the matter:  sometimes you do great and feel awesome and sometimes you do stupid things that make you feel ridiculously embarrassed and/or self-loathing.

I prefer to laugh rather than cry; I usually feel better afterward.  But sometimes you need to cry.

I got my most recent draft of my thesis back a couple of days ago and the short version is:  MAJOR FAIL on the particular section this draft focused on.  I felt I wasn’t being assertive enough at the hospital, my ‘A’ sections had a couple of days of being more lackluster than usual, I was getting my application and cover letter for a particular job I am coveting, and, of course, it was time for my midterm evaluation.  It was a bit much, and a lot of one insecurity (my making a major mistake on my thesis) feeding into others (finding a job, those damned ‘A’ sections, general worry about doing well at my internship) and it’s kind of a vicious cycle.

So after a lot of flailing and general acting/feeling like I have never succeeded at anything in my life, I got home, had a good cry for about fifteen minutes, returned to my laptop, and (fingers crossed) fixed the mistakes on my thesis and re-submitted it.

The point is to pull it together, push forward, and try again.  (And maybe find something to laugh at to cheer yourself up.)

Em Bee Es

*drum roll* Modified barium swallow (MBS) time!

Where I am working, an MBS is scheduled to take about 2 hours time.  Now, I have no other basis for comparison, but I suspect this is on the luxurious side of things.  I’ll talk about what we do, though, in that 2 hour time.

If we have never seen or met the patient before, we meet the patient first and hear about their complaints with swallowing and a bit of a medical history.  While we’re there, we also make sure they know why they are there and what an MBS entails, and do an oral mech exam.  Then we all make our way down to radiology.

If we’ve already seen the patient, our MBS study starts here.  In any case, the client signs in while we go set up in the back.  We grab all the barium-filled food:  thin liquid barium, nectar-thick barium, honey-thick barium, pudding barium, and a package of Lorna Doone cookies that we put the barium pudding on.  Yum, right?  (That reminds me, I really need to try this at some point, just so I know what my patients are eating.)  Then we put on our lead clothes to protect from the radiation.  There’s both a skirt that Velcros around the waist and a vest with an extra piece to cover your neck.  It has taken me a hilariously long time to learn how to put all the pieces on correctly.  Yep, that’s right, every time we have an MBS everyone gets to stand around and watch the new intern struggle to put on protective wear.

They bring the patient in.  Normally, the patient has to stand because the x-ray machine is very narrow.  However, for patients with limited mobility there is a special chair that is narrow enough to fit in the machine.  So far, all the patients I have seen have needed the modified chair.  In any case, once the patient is in the machine, the radiologist comes in.  We all stand around the monitor (the patient can watch to) and we point out some landmarks for the patient so that can have an idea of what is going on during the study.  We follow Jeri Logemann’s protocol of first starting with thin liquid, then pudding, and then doing the other thickened liquids and barium cookie as necessary.  The order of presentation is  3 ml (1/2 teaspoon), 5 ml (full teaspoon), and then a full sip or bite as needed.  If the patient can feed themselves, let them do so, but you might want to give them the presentation sizes yourself (e.g. the half teaspoon), especially if you think they are aspirating.

You present the bolus and then watch the screen for the swallow.  If the patient is cognitively capable of following directions, it’s helpful to tell the patient to hold the bolus in their mouth and then swallow when you say.  To reduce radiation, the radiologist will only turn on the x-ray during the swallow.  The radiologist’s position is usually such that they can’t see when the patient has the bolus and is swallowing, so saying swallow to the patient and/or nodding to the radiologist to let them know when the patient has swallowed is helpful.

As with the bedside swallow exam, if you observe the patient having difficulties when swallowing, you can try out certain compensatory strategies as well as thickened liquids, such as tucking the chin, multiple swallows, and so on.  It is always, always, always better if you can give the patient strategies rather than thickened liquids and/or an altered diet consistency.  I mean, think about how you would prefer to have your food?  I think you’d rather tuck your chin for every swallow than be stuck on a puree or thicken-liquid diet.

Anyway, that’s basically the MBS.  Here, the swallow study is recorded on DVD and we watch it afterwards with the radiologist and talk about what we saw.  That, based on various reports, is not the norm in most hospitals (probably 99%).  In most hospitals, you have to make the diagnosis on the spot about what’s being aspirated, if the hyoid bone and larynx aren’t lifting up and forward, if the epiglottis is inverting, and so forth.  I’m trying really hard to watch everything while I’m doing the study and not rely on the review of the video afterwards since I know that luxury will not be available in almost any job I may have in the future.  It’s really hard.  I love doing the MBS, but trying to catch every part of a swallow that takes approximately 2 seconds takes some serious practice.

Anyway, after that, we go back to our offices and discuss the results with a patient.  We happen to have a handy model that we can use to demonstrate what we saw.  If you don’t have a model and/or picture handy, you should.  One of the requirements for my dysphagia class was being able to draw all the structures important in a swallow and I’m glad I did.  If I’m ever in a pinch, I can always draw a model to use for explanation.  You explain if there need to be any diet modifications and what those are.  And, of course, ask if they have any questions.

Whew!  Is it any wonder they schedule a full 2 hours for it here?  We’ve never gone the full 2 hours, but it has usually take about 90 minutes each time.  Maybe that will get faster now that I have the lead clothing down.

PRAXIS II

Yesterday, I arrived obscenely early at the testing site to take the Praxis II.  I had my roommate drop me off before she did our weekly grocery shopping and then quickly found the floor and room in which we would be testing.  I had heard the building was a bit of a maze and wanted time to find the right room.  (Un?)Fortunately there were signs everywhere directing you to the appropriate testing area so I went directly to the room and waited around for half an hour.  Quite a few of my classmates were taking the exam that day, too, so when they arrived we chatted and hung out.

It was finally time to check out when the proctors for the test emerged from the room and announced that we could not bring our cell phones into the room (a recent new rule by our friends at ETS.)  Dismay all around.  Quite a few of us had been dropped off and so could not run back to our cars to stash our cell phones.  Additionally, the closest parking garage was about 7 minutes away.  Luckily, one of my friends had driven and was kind enough to take my cell phone and stash it in her car.  Several of the other people testing (it wasn’t just SLPs in the testing room) were generous as well, and everyone managed to pawn off their phone to someone to keep for the duration of our test.  We were pretty upset, of course, since we had not been told of this in advance (Thanks ETS!).  So, all of you taking the Praxis II in the coming months:  LEAVE YOUR CELL PHONES BEHIND. (And complain to ETS if you get the chance.)

Not an auspicious beginning.  Nevertheless, we all got checked in sans cell phones and the testing began.  Overall, I feel pretty good about it.  For those of you who have yet to take the Praxis II and might be worrying about it, let me say this:  If you have confidence in what you have retained from your graduate classes and/or have passed your graduate program’s comprehensive exams, don’t worry, you’ll do fine.  I wouldn’t freak out and study like crazy.  I reviewed a couple areas where I thought I was kind of weak in about two hours the night before the test.  Of course, I won’t know my actual scores for about a month.  I’ll let you know if I pass and if my wisdom remains wisdom when the scores come in.

At the very least:  DON’T PANIC.  It’s really not that bad.

A few other points of interest regarding the Praxis II:

• LEAVE YOUR CELL PHONES BEHIND (already stated above, but worth the second mention)
• bring your own #2 (NOT MECHANICAL) pencils
• have your ticket with you
• have a valid ID with your picture, name, and address
• when you print your ticket, make absolutely sure that name matches the one on your ID (that it’s not misspelled, not a nickname), otherwise they won’t let you in

Questions?

Paper. Work.

Actually, paperwork is not a new experience for an SLP at any stage.  Paperwork tends to take up a rather unfortunate amount of our time which we’d rather be spending in therapy.  A sort of necessary evil, I guess.

So, a few days ago I mentioned the Giant Load of paperwork I got from the hospital at which I will be externing.  I have gone through it by now and it is much less vomit-inducing that it was originally (and I mean vomiting from nervousness).  For those interested in the whole SLP grad school thing, you might be interested about the process behind a hospital extern.

First of all, there has to be a contract signed with the hospital.  Of course, there is also contracts signed with schools, but I have a feeling these are usually much simpler than the hospital ones.  In hospital ones, it is not uncommon for the lawyers to have some back-and-forth about God Knows What in the contract before finally (hopefully) agreeing and signing off.  Sometimes it does happen that the two institutions (that is, the school and the hospital) can’t come to a legal agreement, but not very often.

The following is a list of documents I received from a particular hospital.  Your mileage may vary; every program/hospital/whatever is different.

• First, I received a letter about the documents they needed right away, information about my orientation, and when and where I would be meeting on my First Day.
• I got a map to the hospital.
• I got a map of the where the rehab department is located in the hospital.
• I received an entire page of guidelines about the case presentation I will be presenting to the staff (cue: nerves; I still can’t look at this piece of paper for very long).
• I received a confidentiality agreement that required more effort on my part than I thought was necessary
• I got a document with general information about the department of rehab (Well, the bit about food was good to know.  Oh, and I guess dress code, parking, and housing were important too. ;)
• A piece of paper where I provide all my health data (shots, TB test; you have to get all these things for your graduate school clinic anyway so the information was already at hand)
• Student Orientation Information (I also can’t look at this page very long.  Too much information.  Too much for me to worry about in advance.)
• The Student Program Philosophy.  Concise version:  Sink or swim.  And always let the patient know they are working with a student.
• 3 pages of Student Practicum Objectives.  Also terrifying.  I mean, I am very grateful they sent this to me; it’s nice to know in advance what is expected.  Mostly I’m just trying to read the Week 1-3 objectives and block out the rest until I’m actually at the hospital. (You’ve got to take things one at a time.)

That last one, in fact, brings me to another piece of advice to all future/current SLP graduate students.  Take things one at a time.  You can’t do everything at once and no one expects you to.  Besides, you will be surprised at how much you can get done one thing at a time.

There are several things going on these last couple weeks of school.  I will try to sort my brain out over the next few days and post about them (evaluations, end of practicum thoughts, leading a case conference, quarter progress reports, Praxis II, thesis).  I am resolved not to drop the ball with blogging despite my constant re-enactment of Chicken, With Head Cut Off.

I can do this.  It’s not productive to think anything else.

(Despite Today) Reason # 132

Today was a day of FAIL.  These happen sometimes.  I found they happened more often earlier in my graduate career.  But they still happen (to everyone; not just SLP students).

I left the box of Therapy Stuff we cart back and forth in a rolling box in the trunk of my car (we took R’s).  I had to copy-white out-copy another kid’s word web since I’d left the book with the original in the cart in the trunk of my car.  The book R was going to use for one of her activities in one of the groups we split was also in my car.  I left my laptop at home.  I found out I have to make up one of my snow days.  I had to hunt down two of my kids in the Title I room which took up half the therapy time.  I could not keep a single pile of sound cards organized (multiply this by at least 2 sounds per kid x the 6 articulation groups I saw today).  I also couldn’t stop knocking my activity off the table.  I had the wrong cards when practicing present -s tense (these were also in the trunk of my car).  So basically the day snowballed from leaving the Therapy Stuff in the trunk of my car.

I headdesked a lot.  But I also laughed a lot.  If I could only give one piece of advice to future graduate clinicians (that would be hard; there are actually two key things I would like to impart) it would be this:  learn to laugh at your mistakes (and disasters) as quickly as you can.  You’re going to be very stressed out, and no matter how organized and awesome you are as a person, you are going to make mistakes and sometimes entire days are going to feel like a complete failure.  The sooner you learn to laugh at it (perhaps a slightly hysterical laugh, but a laugh nonetheless), the better off you will be.  You will probably have at least one break down where you cry, and that’s okay too.  But learn to laugh; you’ll feel better afterwards.  And some things are out of your control (see also: knocking all the phonology cards off the table).

(The second piece of advice is this:  fake it ’til you make it.  I live by this.)

But this story has a happy ending!  I may have had a complete mess of a day, but there are some things that make it worth it, despite the crazy day.

Me:  Let’s try that sound again.  Remember to keep your tongue behind your teeth and round your lips!

Kid (apologetically):  I didn’t get that one because my tongue was nervous.

Priceless.  That’s why I SLP.

Midterm WIN. Midterm FAIL.

Yep, it’s midterm time! …By which I mean it’s halfway through my school externship, which means it’s time for an embarrassing story, some soul-soothing, and goal setting.

FAIL

My supervisor and I were going over the midterm paperwork that has to be filled out and returned after school.  We get around to the sheet I have to fill out, only to discover that I have filled it out completely wrong and have to re-do the entire thing.  This was particularly embarrassing after my supervisor had been overall very complimentary of my work thus far in the externship.  So, R kindly made an extra copy of my midterm sheet and I filled it out again and went over it with her.  That done, it was time for use to leave, so I put all the paperwork into an envelope (also kindly provided by R) to drop off at the University on my way home.  We carpool, so I rode in her car until we got to the parking lot where we meet up.  I transferred all my stuff into my own car.

Or so I thought.  It turns out, upon arrival at the University, that I had left the envelope in her car.  Or at School 2.  I’m still not entirely sure where that damn envelope is, but I am quite angry with myself for making such a stupid mistake.  (It’s always the stupid, small things!)  Well, I left a message on R’s voicemail, just to let her know that I thought I might have left it in her car and that I would collect it when we saw each other next.

A tip for all of you interested in becoming an SLP:  Don’t make small, stupid mistakes during and immediately after your midterm review!

WIN

As I mentioned above, my supervisor was complimentary overall with my performance thus far.  I am happy to hear it, and also happy that I am enjoying working in a school, which I wasn’t certain of.  I’m also excited about starting the writing portion with some of my older language groups and a lot of things coming up, including:

• District SLP meeting
• Evaluations!
• Picking up a voice client
• Writing progress reports
• Leading classroom language groups
• Observing the middle school
• Observing in the classroom
• The possibility of a home visit

GOALS

• Really modifying my language so it is less “adult;”  I have a big vocabulary and I use it, regardless of who I’m working with.  Tailor my speech to fit my audience; so use kid-friendly language (This is something R really suggested I work on)
• Related to the above, showing and/or doing what I want the kids to do instead of trying to explain it all in words.  As one of my past supervisor’s said, “If they could learn things that way, they probably wouldn’t be coming to see us.”
• Find more than one way to explain things and not use the same explanation over and over, especially when it’s clear it’s not working
• Keep learning peoples’ names!  I think I have about 7 names in my repertoire now; not good for being at the halfway point.

Hopefully things will continue to look up from here.  I have a lot looming in my future, so I know freaking out over a couple embarrassing mistakes won’t help me much.  I need to focus on what is next.  It’s far more interesting anyway.