[Physio Explained] Managing new graduate expectations and preventing burnout with Melanie MacKinnon

In this episode with Melanie MacKinnon, we discuss the new graduate mindset in Physiotherapy. We explore:

·  Factors that affect success for new graduates

·  Core beliefs and values of Physiotherapy

·  How to prevent burnout in new graduates

·  Emotional intelligence and how to find your purpose within Physiotherapy

·  Managing new graduates expectations within clinical practice

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Melanie MacKinnon is a physiotherapist, clinic owner, and Assistant Professor (Teaching Stream) at the University of Toronto, with over 20 years of clinical experience. She is a Fellow of the Canadian Academy of Manual and Manipulative Physiotherapists (FCAMPT). Her work focuses on helping physiotherapists navigate the transition from training to real-world practice, ethically and effectively. She is currently completing a PhD in Health Professions Education.

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Our host is @James_Armstrong_Physio from Physio Network

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Transcript

SPEAKER_01 0:03

You know, when we're in school, we know the game, right? We know what we're supposed to do. We have this unit, these are our quizzes, these are our tests, these are our practical exams. You know your benchmarks for performance. You get out into clinical practice, each patient has different benchmarks for performance, right? Each patient has a different goal. And so to meet their goal is going to be different than the person you saw before and the person you saw after.

SPEAKER_00 0:29

Welcome back to Physio Explained, the Physio Network podcast where we explore the ideas and frameworks that shape how we think, grow, and practice as physiotherapists. In today's episode, we're diving into the concept of the new graduate mindset, a conversation that goes far beyond clinical skills. Transitioning from student to practitioner can be exciting, but it can also feel overwhelming. And this episode is all about helping new physiotherapists build clarity, confidence, and a strong professional foundation. I'm joined by Melanie McKinnon, a practicing physiotherapist with over 20 years of clinical experience, a multidisciplinary clinic owner, and assistant professor in the teaching stream at the University of Toronto. Melanie co-leads the Advanced Muskoske unit and teaches extensively on transition to practice topics including professional values, employment models, leadership and entrepreneurship in healthcare. She is a Fellow of the Canadian Academy of Manual and Manipulative Physiotherapists and mentors within the National Advanced Practice Programmes and is currently completing her PhD in health professional education research, exploring how we better prepare clinicians for the real-world complexity of practice. Together in this episode, we explore three key themes. First, identifying core values and why understanding your personal and professional drivers is essential for shaping decision making early on in your career. Secondly, we discuss defining good work, building on the work of Daniel Goldman and the role of self-awareness in aligning your practice with what truly matters to you. And finally, we unpack the virtues of being a new grad, how curiosity, humility, and adaptability aren't weaknesses but powerful strengths that help foster deeper connections with patients. So whether you're a new graduate, supporting new staff, or simply reflecting on your own professional growth, this episode offers a thoughtful and honest perspective on building a meaningful physiotherapy career. I'm James Armstrong and this is Physio Explained. Melanie, welcome to the Physio Explained podcast. It's it's great to have you on. Really looking forward to this chat today. Thank you so much. I'm really excited to be here. Yeah, definitely. So I'm sure we have lots and lots of listeners that are relatively new to practice who've started their, you know, exciting but sometimes intimidating, anxiety-inducing, worrying, exciting time of their life going into physiotherapy practice. And this one's gonna be a great one for them and also I think really important for some of the listeners who support those individuals coming into practice. So it's gonna be really, really good. And we're gonna talk about the concept of the new grad mindset in in physiotherapy. Just first of all, summarize, what do we mean by new grad mindset?

SPEAKER_01 3:21

As you know, I am an educator, so I teach in the physiotherapy department at the University of Toronto, and I also work clinically and I own my own practice. So I hear it from both sides. I hear it as the educator. The students are very excited to graduate and start working. And then also when you start saying, this is, you know, a few weeks and then you'll be in our profession, they get quite nervous at a little bit of that deer and headlights. So it's that combination of nervous excitement. Can I actually do this? Can I get out of the university and start working? And, you know, as a colleague and as a business owner, you see it too. They're excited to start seeing patients, excited to apply, and then also uncertain if they have the knowledge, uncertain if they can actually help people, because that tends to be the main driving force by people going to physiotherapy. And I think, you know, for me, I work in private practice, and that's where about 65% of our graduates in Canada go is into a private practice kind of fee-for-service setting, not the public system like a hospital. And when you add that layer of charging for your services, that nervousness increases. Like, am I good enough? Can I charge this? Am I worth that money? Is someone gonna get better? And so that new guided mindset is full of excitement and curiosity to become quote unquote the adult that they've been hoping to be for some time and be the profession, be the physiotherapist, but also then this mixed sense of nervousness.

SPEAKER_00 4:50

Absolutely. Yeah, and you you added on there really nicely that increased self-doubt when someone's paying for the services and that that dawning sense of someone's paying to see me for my expertise. Well, it is really, really difficult.

SPEAKER_01 5:06

It's so difficult. I mean, you know, when we're in school, we know the game, right? We know what we're supposed to do. We have this unit, these are our quizzes, these are our tests, these are our practical exams. You know your benchmarks for performance. You get out into clinical practice, each patient has different benchmarks for performing, right? Each patient has a different goal. And so to meet their goal is going to be different than the person you saw before and the person you saw after. So benchmarks for success success are different. We don't get a report card at the end, which many students are happy to not be graded at the end for sure. But you do get graded. Does the person come back? Do they get better? Do they meet their goals? And then if you're in private practice, you also have the impact of business coming into it. And, you know, at some point you have to put food on the table, you have to pay for your rent. You may have a business owner that has different perspectives on how to run a healthcare business. So there's lots of layers and tensions that come in that now you you're uncertain. To me, the way it seems, is uncertain of the the benchmarks for success on multiple different levels of your professional life.

SPEAKER_00 6:14

Absolutely. And that leads us really nicely into our first of three key points that we're covering today. And that's that's identifying those core values, which I think is is is really utmost of importance when, especially when we're talking about private practice as well, because there are and can be some conflicting values there as well, if we're really honest. So, yeah, talk us through a little bit more about that, Melanie, to the core values and what understand.

SPEAKER_01 6:38

Sure. So I think first we'll start with like understanding values. When we say values, we mean these are like convictions, these are really stable, kind of enduring beliefs. And we have personal values that are shaped by our family, our social networks, where we grew up, what city, what community we were part of, where we had our education. So those tend to be quite stable and enduring and can be quite hard to change over time. And so values tend not to be situation specific. They're kind of these global. So, like honesty, family, those tend to be just kind of overarching, stable concepts. If we distinguish that between something like an attitude or opinion, those vary by context, right? I don't like online classes. Well, unless it's this person, then maybe it changes my mind. So that we want to just differentiate. So when we're talking about values, we're talking about more of those enduring things that are formed from a young age. And then we have professional values. So you come into a profession, you're socialized within that profession. What are the norms of physiotherapy? What are the norms of nursing or medicine? They are different and subspecialties can be different as well. And so we're guided by both our professional values and our personal values. And sometimes when you start into a program, your personal values sometimes can conflict with some of the professional values in terms of how they are enacted in that profession, in that, you know, in Canada here, in our province, but a greater part of the country as well. And then there is a process of socialization. So I think that is where we see, you know, early in the training versus towards graduation, there's the socialization of what our professional shared values are for the most part. So it's important to understand both those things are happening, but that often they're not always made explicit. There are, there's, there's elements of that that are quite implicit. And so when we're getting onto professional practice, making those more explicit, what are our personal values, what are our professional values, and then how do we identify that in a potential workplace is quite important for a number of things for our own health and well-being. But it's also something to counteract burnout and imposter syndrome that I think right now are quite coveted concepts and we're hearing a lot about.

SPEAKER_00 8:56

Definitely. And do you see in your practice some of those core values, whilst they they're quite a systemic, if that's the right word? So that they they they are by definition core. Do you see them change gradually over time? Do you or adapt or evolve with the individual as they as they go through practice, or do they really normally stay true to those core values?

SPEAKER_01 9:18

They do stay true. And what I where I see it adapting is when people are trying out new places. So certainly, you know, I've owned a clinic now for 14 years. People are excited to join the clinic because, you know, they're looking for mentorship, or they are excited that a number of us at the clinic participate in teaching. So they they come for that kind of sense. And then for some people, they I have it has happened where they start to realize, oh, you know what, maybe this isn't exactly what I was looking for. So certainly people do pivot out, but it is that process of uncovering what becomes important and how they want to enact that. And I think a big catalyst for us as the whole world was COVID, right? Even pre-COVID, I would have said I was a healthcare provider first and then a business person second, putting that value first in terms of how I wanted to run my business. And then when COVID hit, I really had to evaluate that and say, what does that mean? Like, how do I try to be the healthcare provider first in such uncertainty and such financial uncertainty as well, as we had significant closures? So I would say when people like I was giving the example of someone who maybe transitions out, I think it's not that their core value is changing. I think that their core values are becoming more explicit and they're starting to realize where there's alignment and when there isn't alignment. And certainly COVID was a big catalyst for people to say, okay, do I really want to live in Toronto? Do I want to move out of the city? Here's an opportunity that's giving me big change. So I guess I see it more as finding ways to really align and reconnect with those values. And when people putting my my clinician hat on, but also my academic hat, I think when there is more uncertainty and discomfort, it's when there's a malalignment there. And once you can figure out where that is, I think that's that and gives people courage to then take a step and move closer to aligning their values with what they're doing.

SPEAKER_00 11:24

Are you struggling to keep up to date with new research? Let our research reviews do the hard work for you. Our team of experts summarize the latest and most clinically relevant research for instant application in your clinic. So you can save time and effort keeping up to date. Click the link in the show notes to try Physio Network's research reviews for free today. Absolutely. And I can imagine it comes with experience and time and exposure to even become sometimes conscious of what those values are. And it's like you said there, actually express those explicitly to yourself, if no one else.

SPEAKER_01 12:00

Yeah. And and like I said, I for us at the place where, you know, my clinic where I work, it's really important for me that I create a place where people can do both. They can be a clinician and they can explore other things they want to do, if that's teaching or mentoring or whatnot. And I think that has brought a certain group of people to me as a result. So we have this shared approach. And I think that feeds into like our next point that we were going to talk about today, which is the idea of defining good work. And that comes from Daniel Goleman, who's been researching emotional intelligence for decades. And there's different concepts of what is important in terms of emotional intelligence. There's some that are more important to us as individuals. So, like self-awareness and self-management. Can we read our own emotions and recognize the impact on others and how they guide our decisions? And can we control those and adapt to situations? And then there are other competencies which are related to relationships. So social awareness. Can I sense your emotions? Can I read off that and adapt? And then overall relationship management, those kind of cores to emotional intelligence, in order to be more self-aware and read our own emotions and understand why we react a certain way, we do need a sense of what our values are. So what is guiding us? Why are we reacting this way? What is that triggering? And as we said in the beginning, if those values are really stable, enduring, that can be why we have sometimes strong emotions and in situations. And what I really like about some of Daniel Goldman's work is he talks about this concept of good work. So it's take what you're great at, your excellence, pair it with what you love doing, what you're passionate about, that's your engagement, and then aligning it with your purpose and your meaning, and that's your ethics. And as he says, when those three things come together, then you're on fire. Then you're like in the zone and you're able to adapt. And so this is a concept that we talk about with our soon-to-be physiotherapy graduates about what would that look like for you? What would your good work be? And in order to do that, we have to make some of those implicit more explicit. So we go through an activity about thinking back to an encounter you had that made you feel really good, like a patient encounter on a on an internship. Maybe it was something in school, maybe it was an experience you had with a physio coming into the program. But what was something that really just made you feel really good about what you did and trying to unpack that and understand what was driving you and what that was igniting in you. And when we can tap into that, maybe we get a bit of a better sense of our values, how we can recognize them in ourselves, and then how we could recognize them in a future place of work. Because work is hard. When we get out into quote unquote the real world, there's a lot of things pulling at us. And working with people can be really draining, can be emotionally draining because physios, when I pull the students every year, then in the word cloud, prominent is they want to help people. And when you so want to help people, and if you're not helping them the way you hoped you could, then that gets hard. And so I think this idea of what is good work is a nice way to ground us on those days when we felt like we delivered less than we we wanted to.

SPEAKER_00 15:13

Definitely. It puts puts you in the place where you're likely to care for people the best as well and do good work, as you say. But I like the idea of this in terms of lots and and I was one of them when you when you first graduate, you really don't have any clue as to maybe where you want to be. And sometimes that can be stressful in itself, is to see the odd person who is so driven to be and go somewhere because they know exactly what they want. But actually, I think the majority of people don't really know that. This is a really nice concept to an exercise, if you like, to start thinking about where that good work you'll do might take you and might and you might end up. So the last point we've got here is some of the virtues of being a new graduate. Talk us through this. We're going to talk about sort of things like curiosity, humility, and adaptability now.

SPEAKER_01 15:58

Yeah. So this is the idea that sometimes we're at our best when we quote unquote know the least, right? That when I talk to other colleagues in academia, that we're always surprised that when the students graduate, they feel like they know nothing. They feel like they're not ready. They feel like they have to go out and take all these courses. And sure, we're biased. We like to think we've provided a good entry-level education, but also this idea that those fundamentals are so important and they they really are equipped with those fundamentals of listening to the patient, asking questions, what are their goals, and how do we create a plan from that? You may not at your fingertips have all the protocols for an ACL return to play for each specific sport, or understand all the ins and outs of neck pain, but you do have such a strong foundation to build from. And sometimes the longer people have been in practice, the more ingrained they are in seeing things a certain way, in making assumptions, thinking things are certain clusters. And there is some research. So this idea, there's it's called the rookie smarts. So Liz Wiseman, she wrote a book on it and she's an organizational business. So she she talks about some research that found that sometimes rookies actually have a higher level of self-awareness than more experienced individuals. And I think that comes from this uneasiness and getting in and trying to connect with how we're feeling and understand what's happening. And that can really serve us well in these situations where we don't have all the answers because maybe we do hold back and listen a little bit more or take paths that the expert has pushed away that maybe sometimes could be helpful. So when I speak to students about this, it's this idea of that growth mindset. You come in with your existing clinical reasoning frameworks and listening and making that connection with the patient is so important. And it's okay to say you don't know. And it's also important to say how you're going to find out and how you're going to make it work for them, right? So there was an interesting study that came out a couple of years ago that looked at why, out of these states, that looked at why patients leave practice, like don't continue with their treatment plan. And more often it was because either they got better or sometimes there were barrier issues. But the other ones that are more practitioner-related had to do with the idea that the goals weren't as clearly communicated and that maybe the person wasn't being as transparent in kind of the next steps. And I think they're not necessarily looking for the right answer. They're looking to see do you understand what they're coming to you with? And do you have a plan to try to address that, whether or not you have all the little pieces filled in? And so I think that's where being a rookie can be really helpful. Often they're not afraid to ask questions and they embrace that. Okay, I I don't have all the questions, so happy to go to other people and get that information. And I think this is also where we see it in the literature where the new grads are looking for mentorship. They want a place that they can have a mentor and colleagues to chat with and engage with. So when they're a rookie and they're able to engage that mentorship gene in others by asking questions, that what is what can create a really dynamic workplace that is serving those new grads and then also maybe reinvigorating the practitioners who've been there in order to share their expertise. We we, you know, every year try to help ease some of the uncertainty by letting the students know that you're actually in a really great place being a rookie because you're willing to embrace some of the uncertainty a little bit more, and then sometimes more experienced people are.

SPEAKER_00 19:27

Absolutely. And that that keys, that that humility and and curiosity, I think asking questions, but also just being very, very, very aware, sometimes too aware that you don't know everything. So you're going to need to ask questions, and that's okay. And as you maybe go on through your career, you you forget that you don't necessarily know the all the is and there might be something else that you've not come across. Whereas as a student, as a as a rookie, as you say, you're really aware of that.

SPEAKER_01 19:54

You are. And I think the other interesting piece is that we're not always the best at self-assessing where we are. And we know that when learning is challenging, that tends to be when we make the most connections and we and we it makes learning really meaningful. So sometimes that struggle that we're in in the moment where we're feeling like we're not good enough, we're actually right on that growing edge and we're doing really great work. And so if you go back to what were the patient's goals, did you meet the patient's goals? Or are you transitioning closer? Are we trending positive towards the patient goals? Then you're doing your your best work. That's great. That's right where you're supposed to be.

SPEAKER_00 20:33

Yeah, absolutely. And sometimes that just needs that mentorship as well to draw out that and and to assess that with the the new grad as well, so they can support them to see where they are and what's the next step and what does that path look like? And then that leads you really nicely back into those core values and what good work is to continue a sort of a relatively structured part. Melody, it's been brilliant chatting to you. It's it's a big, big topic, and we've only scratched the surface really of a very small part of it, but it's been really interesting. And and hopefully, some some of the people listening to this and new grads or or down the career might get something for this in terms of some of those three things on core values, good work, and some of those virtues of being a new graduate.

SPEAKER_01 21:18

Thank you for having me, it was fabulous.