How do I choose a fellowship program?

Photo By Joseph Young via Unsplash

Since graduating from a fellowship program in 2012, I frequently field questions from colleagues and DPT students about the benefits of fellowship education. It’s easy to list the many ways my clinical skills have advanced, how my professional development has accelerated and how I love the field of physical therapy even more now than I did before fellowship training.

What’s not easy is answering the question “What are the similarities and differences between all these fellowship programs?” or “Do you think X,Y, Z program would be a good one for me?”

With 43 accredited fellowship programs how does one even begin? On the ABPTRFE website they are categorized into Critical Care, Hand Therapy, Higher Education Leadership, Movement System, Neonatology, Orthopedic Manual Physical Therapy, Spine, Division I Sports and the Upper Extremity Athlete.

Let’s say you’re interested in an orthopedic manual physical therapy fellowship program. There are still 25 different fellowships to look into. Now I have been to the annual AAOMPT conference five times and have met and had conversations with numerous faculty, alumni and fellows in training from a variety of organizations, yet I don’t think I have more than a passing knowledge on many of the programs.

Visiting the 25 individual program websites in an effort of gain information is tedious at best. Could there be a better way to efficiently consume this information? One that would at least have basic information (duration, cost, # of graduates, etc.) in a central listing to serve as a launching pad?

The challenge of fellowship education should be elicited once you are in a program. Not while you are attempting to gather information about them.

A similar message was brought up recently by DPT student Zack Duhamel, his thoughts are below.

As usual, there is a healthy amount of talk going on in student/new grad circles about continuing education options. This conversation usually goes two places: 1. “I am dead set on (fill in the blank) residency/certification because my CI was all about it and they were super cool!” or 2. I have no freakin clue what is going on in that world. The funny thing about me is that I feel like I can kind of resonate with both of those but I want to draw some attention to a gaping hole in our education and maybe get some help.

I am a third year student, 3 months from graduation and like most ambitious SPTs I really want to learn more and be a great PT, which has inevitably lead me to looking at structured continuing education models. As I started this search I was directed to APTA’s Residency and Fellowship website which basically lists them all but gives very little helpful information. So, I took to the only other place I knew I could get answers…the DPT Student Facebook page and I posted this:

Zach Duhamel FB post photo

This lead to a long string of messages that confirmed that there is a huge need for education about post grad educational opportunities. We, the students, need to know what the heck is going on. What does one group believe vs. the other? Which one is best for me? Are any of them right for me?

I don’t think these questions are being answered well right now. I propose we build a platform to REALLY understand the ins and outs of these programs and groups so that we are not going into them blind but confidently, knowing it is the best fit for us. How can we do this? A few ideas have been tossed around, but I think the best one so far is a short (2-4 minute video) of a representative from each group that answers the same set of 4-5 questions. These questions shouldn’t be ones that we can simply look up, like cost, duration or location, but questions like:

  1. What classification system is used?  Tissue vs. Movement diagnosis
    1. thoughts/ beliefs on ability to dx tissues specifically
  2. What is the treatment philosophy?  
  3. How is the Exam structured?
  4. How has fellowship training changed your practice?
  5. What is the ultimate reason for choosing the Fellowship you chose?

These questions are by no means the only ones to be asked or the right ones but I believe that they drive to the real heart of what continuing education is about. These are the types of questions that students and new grads are asking but that are not getting answered, at least by multiple groups, which makes the decision of what route to go down increasingly difficult.

If you are a fellow, resident or have completed a certification and would be interested in helping make this happen comment below or tweet either of us @AmyPakulaDPT or @zduhammy, and copy @PTThinkTank so we can keep track.


This post is by new author, Amy Pakula. Welcome to PTThinkTank.com, Amy!

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Dr. Amy Pakula graduated from Pacific University in 2008 and completed her fellowship training through the Kaiser Permanente Northern California PT Fellowship program. Amy works in the outpatient orthopedic setting at Momentum Physical Therapy in Bozeman, MT. She has taught continuing education courses to physical therapists in Peru through Health Volunteers Overseas. She has also been a presenter at national conferences and serves as a consultant to the Kaiser Permanente Northern California PT Fellowship program.

#DPTSTUDENT LIVE CHAT TOPIC FOR WEDNESDAY, MARCH 12, 2014: FOUNDATION FOR PHYSICAL THERAPY PROJECT COMMITTEE

Are you a DPT student looking to enhance the future of your profession? Are you interested in research? Do you want to advance the art and science of physical therapy in a meaningful way?

The Foundation for Physical Therapy is the only national nonprofit organization dedicated to funding physical therapy research supporting evidence-based practice.  Over the last 35 years, the Foundation has supported the physical therapy profession’s research needs in scientific research, clinical research, and health services research.

The Foundation has provided more than $13 million in funding to help launch the careers of over 500 physical therapist researchers. New data has shown that Foundation alumni have gone on to receive an estimated $595 million in additional funding from a variety of sources including the National Institutes of Health, Department of Defense, Veterans Administration, and the National Science Foundation.

Many of today’s leading and emerging physical therapist researchers, clinicians, and academicians began their careers with seed funding from the Foundation.  Since its inception, the Foundation has awarded 346 scholarships, 18 fellowships, and 448 grants.

The Foundation’s Student Project Committee is improving ways that PT and PTA students can help contribute to the Foundation’s philanthropic mission. The Miami-Marquette Challenge and the
Log ‘N Blog are both student-led fundraising efforts which help fund the Foundation’s critical work.

Join us on Wednesday, March 12th at 9pm EST to talk about how you can get involved!

Post written by Erica Sadiq

Kinesiophobia: Are psychosocial barriers to return to sport outweighing the physical ones after ACL reconstruction?

Cut, pivot, pop; I’m sure we’ve all had that shock and awe moment observing an athlete rupture their anterior cruciate ligament, especially with the high incidence of ACL injuries in nationally televised sports like basketball and soccer. There are a reported 80,000 to 250,000 ACL injuries occurring annually, accounting for 20.3% of athletic injuries. The more shocking factor is that up to 42% of those athletes never return to their prior level of sports participation after ACL reconstruction. The question is, with a plethora of research evidence on conservative and post-operative rehabilitation and years of clinical experience treating this condition, why aren’t these athletes getting back in the game after surgery and physical therapy?

Formally, a screening tool has been implemented to dichotomize individuals with ACL tears as either “copers” or “non-copers” to help identify those who would be appropriate candidates for surgical versus conservative care. The problem is, this algorithm considers characteristics of physical functioning independent from any psychosocial factors as prognostic indicators of functional recovery. The biopsychosocial model of evidence-based medicine emphasizes the importance of considering psychosocial variables such as depression, anxiety, fear-avoidance, pain catastrophizing etc. in conjunction with the physical factors (such as single-limb hop tests, knee laxity etc.). With an entire rainbow of “flags” representing different psychosocial barriers to recovery of physiological problems these days, perhaps the missing piece of the rehab puzzle is of cognitive-behavioral origins.

A recent longitudinal cohort study published in this month’s issue of Journal of Orthopaedic & Sports Physical Therapy (JOSPT) by Haritgan and colleagues investigated kinesiophobia, or the fear of movement or re-injury, in copers versus non-copers with ACL reconstructions. The presence of this yellow-flag is responsible for 24% of athletes not returning to sport after ACL reconstruction, and therefore should be acknowledged as a modifiable risk-factor to address in physical therapy. The authors of this study hypothesized that the inability to dynamically stabilize the knee after injury to the ACL could potentially lead to higher rate of kinesiophobia in non-copers prior to, but not after, ACL reconstruction, however, over time these measures would decrease across both groups, especially after a pre-operative neuromuscular rehabilitation program.  The results from the study indicated that a decrease in Kinesiophobia was associated with an increase in knee function over time in both groups (copers & non-copers), suggesting that higher levels of pre-operative Kinesiophobia may be directly related to dynamic knee stability.

The findings from this article supports previous literature on joint hypermobility and associated psychosocial issues noting increased psychological distress, such as anxiety, fear, depression, and panic disorders in those with joint hypermobility (pathological or benign) compared to healthy controls. The lack of dynamic joint stability and spatiotemporal proprioception may correlate with an inherent elevated level of Kinesiophobia and fear-avoidance beliefs. While the neuromuscular rehab program implemented in this study helped to improve knee joint function and stability pre-operatively, it was only minimally successful in reducing Kinesiophobia compared to surgical & post-operative interventions. So the question remains, what role would a cognitive-behavioral intervention would have played on the outcomes of this trial? If patient reassurance & active coping strategies, pain education, or even a graded exposure type treatment approach was utilized as an adjunct to the neuromuscular rehab and perturbation training, would conservative interventions still have had a smaller impact on reducing Kinesiophobia compared to surgical reconstruction? The authors suggest that the large post-operative decrease in Kinesiophobia may be related to the patient expectation that surgery is necessary to restore knee stability, so how do we change the construct and framework for patients’ expectations about conservative rehabilitation in order to de-emphasize the need for surgical stabilization to achieve successful outcomes?

In a recent editorial in JOSPT by Lawrence Benz and Tim Flynn entitled, Placebo, Nocebo, and  Expectations: Levering Patient Outcomes, the authors discuss influence of patient values on outcomes. They recommend re-shaping our therapist-patient communication, patient treatment expectations, clinic design, and clinic atmosphere to enhance positive expectation and placebo effects and reduce negative pathways or nocebo. Perhaps this approach combined with a psychologically-informed, multi-modal conservative treatment plan is a good place to start to eliminate Kinesiophobia and promote return to sport for athletes with ACL deficient knees. Clinical bottom line here? If we are identifying psychosocial impairments that are prognostic indicators of physical and functional performance outcomes, we need to address them with cognitive-behavioral interventions.

Communication, education, positive expectations.

Thought of the Week: Help.

As everyone is aware, Superstorm Sandy has wrecked things. Especially, my home state of New Jersey. Many of my friends and family are still without power. My cousin was particularly hard hit as his home in Ortley Beach, NJ was completely devastated. He’s the “Joe” featured in this video and pictured above. Authorities tell him he will not be able to return to his home for 7 months at the earliest. Devastation.

Please click on either of the two links and donate funds to help this stricken land.

American Red Cross Disaster Relief Fund

 

 

NJ Hurricane Sandy Relief Fund
 

 

 

I’m sure my family and friends will be thankful for your generosity.

ERIC

Osteopractor™

The content on this webpage has been removed to protect the interests of all parties involved. We apologize to our readers if you were looking for something you cannot find. We invite you to visit our home page and read our most recent blog posts.

Smart phone “use” by physicians. What do the numbers really mean?

A recent article entitled “Why industry surveys on physician adoption of smart phones could be overestimating reality”at iMedicalApps [Mobile Medical App Reviews & Commentary – A publication by medical professionals] explored what recent market research really means…

It has been cited in market research that 72% to 94% of physicians are using smart phones in clinical practice (Questions: How are they using them? And, how often?).  Josh Herigon, MPH  a second year medical student and blogger at Number Needed to Treat comments:

“Although these studies show a high degree of smartphone adoption among physicians, these results should be interpreted cautiously. These firms provide few details on how they actually conducted these studies. A major hurdle to conducting such research is sampling bias. This can occur in survey research when researchers get a low response rate (i.e.—researchers approach a large number of individuals to fill out a survey but few actually fill it out).”

A little bird told me that a PTJ internal study revealed that no more than 50% of the physical therapists they sampled used smart phones. And, while the percentage of professionals who have and use smart phones is interesting data, I think there is a bigger question to consider. How many physicians, physical therapists, and other healthcare providers who own smart phones are using them routinely and effectively in clinical practice?

Owning a smart phone and leveraging its capabilities during clinical practice are two vastly different things. I am an avid smart phone owner and user, but to be honest, I rarely use my phone in clinical practice. I actually use it most while practicing within the in-patient hospital setting to look up medications, abbreviations, surgeries, and specific diagnoses. But, that is only when I am not near, or logged into, a computer. Admittedly, in the outpatient setting I grossly underuse the capabilities of my phone.

Why are we still giving out paper copies of exercises and patient education? I believe the opportunities for leveraging this technology for clinical support, aiding in clinical decision making, and pt. education are infinite. In my opinion, routine use could actually markedly increase efficiency and quality of care especially in physical therapy. Patient’s use and love their smart phone, so why aren’t we interfacing with them using technology? [Yes, I understand the potential HIPPA considerations and that is not the point of this post]

  • Patient education
  • Home exercise programs: Pictures, videos, directions
  • Pictures and videos of patient performance (motor control, motor learning, and feedback)
  • Documentation
  • Scheduling

Do you think it would be possible to run a private practice and physical therapy LLC strictly from a smart phone. If not, why not? Paper is messy and overated anyway…

Do you have a smart phone? If so, how are you using your smart phone in clinical practice? Do you use specific applications? Any ideas for how we can better utilize this technology as we move forward?

Considering making the switch to a smart phone? Check out this article targeted towards medical professionals: iPhone, Blackberry, or Android?

God Bless You, Mr. Vonnegut…


Kurt Vonnegut has died. He split his head in a fall and last night he died. And so it goes…

“When the last living thing

has died on account of us,

how poetical it would be

if Earth could say,

in a voice floating up

perhaps

from the floor

of the Grand Canyon,

“It is done.”

People did not like it here.”

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