It’s a Strange, New World!

View of San Francisco Bay

Well it’s been a bit. And what a bit it’s been!

I’m presently completing day one of “shelter at home” courtesy of COVID-19. As I am a regular worker from home, some parts of my day has not changed. Others, have changed greatly, and, really, who knows what is to come. I translate all this to: it’s a fine time to start writing again. Thus, new theme, new look, new images, and new thoughts for everyone!

Things on my mind:

Stay tuned. I need to go fixed m “Y” button on m three week old MacBookPro which makes me ver angr .

#dumbcoronavirus #DCV

What’s the Cost of Quality? New ABPTRFE standards mean an uncertain future for Fellowships.

Back in February at the Combined Sections Meeting, the American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE) announced their new quality standards for post-graduate education. The release of the new standards marked ABPTRFE’s first step towards its initiative of revamping old policies and procedures. According to Tamara (Tammy) Burlis, Chair of ABPTRFE, the intent is to“ultimately enhance patient care and support overall goals of the physical therapy profession”. An external consultant company specializing in accreditation and compliance solutions for higher education helped with the development of the new standards. After a 6-month call for comments, the standards were finalized and are now slated to take effect on January 1, 2018. Residency and fellowship programs have until January 1, 2019 to comply. Physical therapy news outlet Talus Media News featured this story in their August 14th episode.

Behind the buzz of the shiny new standards, however, is the discontent expressed by some fellowship directors. The biggest concern regards the change in admission criteria into fellowship programs. Historically, there were three ways to be considered for admission into fellowship: (1) complete an accredited residency, (2) earn board certification in a related field, or (3) have adequate prior experience as judged by the program directors. The new standards have removed the third option, leaving residency training or board certification a mandatory requirement prior to applying for fellowship.

Pieter Kroon, program director and co-owner of The Manual Therapy Institute (MTI), a fellowship program started in 1994 for advanced manual therapy training, spoke up in an interview on Talus Media, “I understand where [ABPTRFE] wants to go with it but…there are some nasty consequences that come with that which threaten the viability of the physical therapy manual therapy fellowship programs…We have given input, but we always have the feeling it doesn’t get listened to a whole lot at the ABPTRFE level.” According to Pieter, fellowship directors don’t seem to have much of a voice in the decision-making process at ABPTRFE. The way in which program directors currently share their concerns is akin to a bad game of telephone. The manual therapy fellowship program directors share their thoughts in their Special Interest Group (SIG) meetings. SIG representatives then report to the Board of Directors at the American Academy of Orthopedic Manual Physical Therapy (AAOMPT). After that, it is AAOMPT’s responsibility to talk to ABPTRFE and pass the messages along. It’s not hard to imagine why Pieter describes the communication between program directors and ABPTRFE “tenuous at best”. Of note, AAOMPT declined to comment on the potential impact of the new standards.

The consequences Pieter referred to are a few in number, but of primary concern to fellowship programs is sustainability. Or, as Pieter more bluntly puts it: “we would be out of business”. To illustrate his point, 95% of the fellows that graduated from MTI in the past five years were admitted via review of prior experience, the route now deemed obsolete. Without such a large section of the cohort, his program would not have had enough overhead to be self-sustaining. Pieter shared off record that he runs his program because he loves teaching and helping clinicians become their best; the revenue the program generates is marginal. The new standards pose a big bottleneck to fellowship admissions, limits student accessibility, and places programs like his on a pathway to an uncertain future.

But what makes fellowship programs think they won’t get enough applicants?

Though there has been a paradigm shift in recent years where clinicians are looking towards residency training soon after entering the work force, there has yet to be an identifiable fiscal incentive for clinicians to become experts in the field given their low ceiling of professional compensation. Furthermore, time is of the essence. The American Board of Physical Therapy Specialties currently only offers certification exams once a year. So, not only are the additional certification exams expensive, it also requires foresight and planning to fit it into one’s professional and personal timelines. There is additionally a current lack of evidence that suggests being a resident-trained therapist and/or having board certification contributes to being a more prepared fellow. Though that’s not to say there won’t be evidence of this in the future, it does call into question how this new admission standard was arrived at. Did it consider any of the current evidence in post-graduate education? Or, was it developed with more philosophical underpinnings? To that end, it remains to be seen…

PT Think Tank community: the point of this piece isn’t to say that the new admission standards are “bad”. Rather, I hope it makes us consider how its proposal potentially overlooks the current reality of the residency/fellowship climate. What parameters are in place, if at all, to help address the worries of Pieter and other program directors? What will be in place to aid them during this period of transition?

I’ll end it here, but do think on this last part of ABPTRFE’s position on the new admissions criteria: “Our goal is to support residency and fellowship programs, while addressing and planning for the future…As a part of our own continuous improvement process, we will continue to monitor the data that occurs as a result of this revised change. We will go back to this concept if we find that it has been detrimental to fellowship programs.”

Pieter and Tammy’s full interviews are available on Talus Media Talks.

Thought of the Week: Be Passionate

Dark Side of the Lens Screenshot

In this stunningly beautiful, award-winning video work from The Astray, the message is about passion. Relax for a few moments and soak this masterpiece in. Let’s gather some friends and เล่น UFABET tonight for some fun.

I never set out to be anything in particular, only to live creatively, and push the scope of my experience through adventure and passion.

Passion is part of what drives the people who make change. It’s part of what makes someone work deep into the evening to make it right. It’s the people pouring out ideas in the #SolvePT movement. It’s the leadership of the profession, regardless of how effective you think they are.

For a long time I had no passion for this profession or my career. Moving from job to job, I had little fulfillment. With a little luck and a little self-exploration, I was able to discover which aspects of physical therapy resonated with me. Fortunate. My passion is now strong. This job has become my profession. This blog is an expression of that passion. What is your passion?

Live Creatively. With Passion. Expand Your Experience.

Thought of the Week: The Garden of Your Mind

The following video was posted by PBS yesterday. Turn up the volume, click play, and enjoy:

Amazing. This video struck a nerve with me instantaneously. I was a young boy at the peak of popularity of Mister Rogers’ Neighborhood in the late 1980s and my grandparents allowed me to watch the show just about every time we stayed with them. Although I was entertained by the characters at that time, watching this remixed video now gives a deeper appreciation of the lessons taught by that great educator Fred McFeely Rogers (1928-2003).

These are those lessons:

You can grow ideas in the garden of your mind.

It is good to be curious about many things.

Every person you see is someone different from every other person in the world.

There are so many people that can help us learn in this world.

Did you ever think of all the many things you can do?

All you have to do is think and they’ll grow.

You should have noticed that Mister Rogers’ voice sounds different in the video compared with what you remember from a kid. That is because the audio has been remixed using an “auto-tuned” style. I am so impressed that an aging network like PBS is reinventing itself by remixing and breathing new life into this iconic shows. Make sure you subscribe to their new pbsdigitalstudios YouTube channel to see what they roll out with next!

What other lessons did you hear in the video? @mpascoe

P.S. – Here is another video of Fred Rogers (1997) giving the best award acceptance speech in the history of mankind –

Thought of the Week: Connect

Recently, the physical therapist social media world has been a buzz with #SolvePT. I added my thoughts on this in a separate post. This movement made me reflect on a Ted Video I watched and enjoyed recently. It got me thinking and it spawned this week’s thought.

Inspired by the video below by Brene Brown, we need vulnerability to connect. I believe the recent #SolvePT is a nice illustration of connection, albeit virtual, happening within the physical therapy profession. Now, taking the leap to join social media, and then leaping into the conversation means putting yourself out there in a virtual, but very real sense. It means expressing thoughts, views, and ideas. Ideas the world and other PT’s can read (and critique!). It is social media vulnerability, but we need it to truly connect.


Now, what about in real life; what about the patients we serve? Many, if not all, come to us in vulnerable circumstances. Sharing their stories, their illness narratives, they are vulnerable. Are we, individually and collectively, creating an environment that welcomes and nurtures vulnerability in order to facilitate connection, understanding, and transformation?

You need vulnerability to connect. What can we do better in our personal and professional lives? Individually and collectively? What can we do better in education of our students and patients?

Thoughts? @Dr_Ridge_DPT

Thought of the Week: MOVE

Our inaugural PT Think Tank Thought of the Week was BE YOU.  This week’s thought stems from a video that has been circulating over the past few months. Inspired by the video below, this weeks thought is:


Slow movements, fast movements, weird movements, new movements!! Time to get moving. Obviously, this video discusses some of the health implications of not moving, and the benefits of daily activity. As physical therapists, we are always trying to assist our patients with movement. How can we best assist them to not only become themselves (per the previous thought of the week), but MOVE more to illicit potentially powerful health, wellness, and quality of life benefits? Your thoughts?

Thought of the Week: Be You

We are starting a new, original feature on @PTThinkTank called Thought of the Week. Other blogs have weekly links, videos, songs, fun posts, and other various features. This will be ours. Since this is a Think Tank, we figured it should be a statement, a thought.

Thoughts may be funny, serious, analytical, and or insightful. Hopefully, they will provoke thought. Posts will likely include links, pictures, and videos that illustrate (or even inspired) the message.  As always, sharing, comments, and discussion are not only allowed, but highly encouraged.

Inspired by the video below (and credit to my graduate school neuroscience professor and faculty advisor @RGisbertDPT) the first PT Think Tank “Thought of the Week” is:

Now, the thought could have been MOVE or DANCE or FREEDOM. But, in the end you can move, dance, and be free to become yourself. So, BE YOU. How can we assist our patients to be themselves? Or, more importantly have them change and move to become the selves they desire?

Your thoughts…?