Physical Therapy Residencies

[PTlife2015]

Hello everybody! I wanted to get everybody's thoughts on physical therapy residencies. Do you think that residencies will be required in the near future? What residency did you complete or are interested in and was it worth it? What do you think is the most interesting residency field? Thanks for the responses!

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[noyceguy]

I think they are a waste of time and money and the therapists they produce are not demonstrably better than non-residency trained therapists.

 

[dylanh]

hmmmm

 

[Sheldon]

Residency training was great for me. The recent study in JOSPT by Rodeghero is not a good benchmark to base your decision to pursue residency training or not, either. Lots more questions than answers.

Residency is where the profession is going, like it or not.

 

[jjjDPT]

Residency is where the profession is going, like it or not.

Can you expand on this?

 

[PTlife2015]

Residency training was great for me. The recent study in JOSPT by Rodeghero is not a good benchmark to base your decision to pursue residency training or not, either. Lots more questions than answers.

Residency is where the profession is going, like it or not.

Can I ask what residency you did?

 

[AlanWattsBlues]

Residency training was great for me. The recent study in JOSPT by Rodeghero is not a good benchmark to base your decision to pursue residency training or not, either. Lots more questions than answers.

Thanks for mentioning this article. I recently heard a classmate talking about this, but I hadn't realized it was so recent. It was mentioned in the context of "research is showing that fellowship trained PTs are better than everyone else." As I actually read the thing, I can see that synopsis is a bit of a stretch.

(As an aside, has anyone else gotten tired of hearing PTs throw out one article to support their point of view, and then you go dig out the article, read it, and find that it's absolute bollocks and that the person referencing it probably didn't get past the abstract? I'm not even out of school yet, and I can see that this is going to be a growing chip on my shoulder for the rest of my career...)

Digging into that article just a little bit started to set off many warning bells. Not the least of which is this:

This project was completed with the support of the 2012 OPTP Research Grant issued by the AAOMPT.

OK. So the authors (who are all FAAOMPTs except for the OT) are funded by AAOMPT. They found 12 FAAOMPTs and compared them with 45 residency-trained PTs and 306 non-residency/non-fellowship PTs. And after controlling for various covariates (a.k.a "fiddling with the numbers") they were able to show modest relative improvements in FS change for those with fellowship training. Yet they acknowledge themselves that these statistical differences may not be meaningful to patients.

So they start trying to look at Odds Ratios that a patient will experience a MCID depending on therapist training...and those odds ratios seem to hover pretty close to 1.00.

It does look like these 12 FAAOMPTs make a more efficient use of time. But I wouldn't be surprised if among those 12, at least half know one of the authors personally. I only say that to underscore that these dozen folks are probably high performers who were essentially hand-picked by the authors. They may have been great clinicians regardless of fellowship training.

Maybe I'm lost in my cynicism...If anything, this article seems to reinforce the idea that residency/fellowship doesn't make much of a difference.

Sheldon, I'd be interested to get your take on it in a little more detail. Do you think residencies weren't well represented here for some reason? What kind of questions do you think future research into this area should explore?

 

[Fiveoboy11]

I haven't read the article. Who is to say though that in the future residency and fellowship training in physical therapy will not yield better outcomes that are meaningful. Maybe the outcome difference doesn't exist or isn't meaningful at this time but what about in the future? Should no PT's do residency or fellowship training until magically these training programs "just figure out" how to train PT's to yield meaningfully better outcomes? Maybe this study and any others like it serve as a means to educational reform and to serve as a baseline of where we stand. And is it just me or are you citing this one study to support your point of view that "reinforces this idea"? You'd think that after these biased fellows "fudged with the numbers" and the supposed conflict of interest that the funding source created as you suggest, they'd have more convincing statistics. I'll stay tuned for your conspiracies in physical therapy series.

I would question the motivation of physical therapists who did or are or consider residency or fellowship training. Is it "about the patient" or to improve outcomes? It should be but I would question whether this is the motivation underlying a PT's decision.

The future of physical therapy is definitely DPT + residency, but probably looking at 20-30 years down the road.

 

[AlanWattsBlues]

Is this string of rhetorical questions and non-sequiters directed at me? I honestly don't know. In case they are, here are my replies.

I haven't read the article.

Congratulations!

Who is to say though that in the future residency and fellowship training in physical therapy will not yield better outcomes that are meaningful.

Not me. Maybe the strawman to my left...

Maybe the outcome difference doesn't exist or isn't meaningful at this time but what about in the future?

Maybe it will be both statistically significant and clinically meaningful when PT is done by robots in virtual reality. I am excited about the future!

Should no PT's do residency or fellowship training until magically these training programs "just figure out" how to train PT's to yield meaningfully better outcomes?

People are free to do what they want. But these things cost time and money and don't seem to offer a clear benefit beyond the anecdotal. I'll let others pay for the honor of being guinea pigs.

Maybe this study and any others like it serve as a means to educational reform and to serve as a baseline of where we stand.

Agreed.

And is it just me or are you citing this one study to support your point of view that "reinforces this idea"?

Um...yeah. That's exactly what I'm doing. I'm not saying that one article proves anything. I'm saying that it reinforces an idea that I see other people express in more anecdotal terms. Which is that this additional training doesn't lead to the significant and meaningful improvements in patient outcomes that might be hoped.

Maybe you think it reinforces another idea. If so, I would love to hear your reasoning. Reading the article is probably a good place to start.

You'd think that after these biased fellows "fudged with the numbers" and the supposed conflict of interest that the funding source created as you suggest, they'd have more convincing statistics.

Given a bias, I just expect the results to be skewed relative to the truth, not relative to the paper that was published.

I'll stay tuned for your conspiracies in physical therapy series .

Yeah...i'm not suggesting a smoke-filled room with the zapruder film playing in the background. I'm suggesting that 2300 people got emails from the authors asking them to participate in the study (this is explained in the article). And there were 19 FAAOMPTs who replied and 12 who had FOTO data that fit the inclusion criteria of the study.

You get a bunch of emails and requests to participate in studies? I do. If it comes from someone I know and see on a regular basis, I'm more likely to take part. And the folks who travel in the same circles as these authors are probably not your average PT who is just clocking in and going through the motions.

Seems reasonable to me. Maybe not to you. I can live with that.

 

[jesspt]

Thanks for mentioning this article. I recently heard a classmate talking about this, but I hadn't realized it was so recent. It was mentioned in the context of "research is showing that fellowship trained PTs are better than everyone else." As I actually read the thing, I can see that synopsis is a bit of a stretch.

(As an aside, has anyone else gotten tired of hearing PTs throw out one article to support their point of view, and then you go dig out the article, read it, and find that it's absolute bollocks and that the person referencing it probably didn't get past the abstract? I'm not even out of school yet, and I can see that this is going to be a growing chip on my shoulder for the rest of my career...)

Digging into that article just a little bit started to set off many warning bells. Not the least of which is this:



OK. So the authors (who are all FAAOMPTs except for the OT) are funded by AAOMPT. They found 12 FAAOMPTs and compared them with 45 residency-trained PTs and 306 non-residency/non-fellowship PTs. And after controlling for various covariates (a.k.a "fiddling with the numbers") they were able to show modest relative improvements in FS change for those with fellowship training. Yet they acknowledge themselves that these statistical differences may not be meaningful to patients.

So they start trying to look at Odds Ratios that a patient will experience a MCID depending on therapist training...and those odds ratios seem to hover pretty close to 1.00.

It does look like these 12 FAAOMPTs make a more efficient use of time. But I wouldn't be surprised if among those 12, at least half know one of the authors personally. I only say that to underscore that these dozen folks are probably high performers who were essentially hand-picked by the authors. They may have been great clinicians regardless of fellowship training.

Maybe I'm lost in my cynicism...If anything, this article seems to reinforce the idea that residency/fellowship doesn't make much of a difference.

Sheldon, I'd be interested to get your take on it in a little more detail. Do you think residencies weren't well represented here for some reason? What kind of questions do you think future research into this area should explore?

(As an aside, has anyone else gotten tired of hearing PTs throw out one article to support their point of view, and then you go dig out the article, read it, and find that it's absolute bollocks and that the person referencing it probably didn't get past the abstract? I'm not even out of school yet, and I can see that this is going to be a growing chip on my shoulder for the rest of my career...)

Check out this editorial from an old PT Journal and you'll realize that this problem has been dogging our profession for years.

If we want to see if residency trianing matters, we likely need to compare several variables that are important to the patient's satisfaction, their outcome, and to the therapist's satisfaction, ideally looking at residency-trained PTs, and their colleagues who are board-certified without residency training.

 

[Fiveoboy11]

These guinea pigs deserve respect and support IMO, not the opposite. There is definitely need for improvement in physical therapy training and patient outcomes and I respect and accept the path we are taking as it is driven by people who know what they are doing. It is and will take a lot of time but I think residency training in physical therapy will prove essential as it has in other professions. The last thing we need in physical therapy is to stagnate or regress.

BTW, there is already robots and virtual reality in physical therapy just not widespread due to cost and novelty. And it's not "done by" them, it's "done by" the patient often with some assistance.

 

[AlanWattsBlues]

Check out this editorial from an old PT Journal and you'll realize that this problem has been dogging our profession for years.

Thanks, Jess. That article goes to the heart of these misgivings I have about the way that I've seen EBP presented. When starting school, I expected to see something like a science model, where people develop theories that generate testable hypotheses that are then examined in experiments. But then that's not how anything panned out. It was just Treatment A vs. Treatment B. There's no attempt to discuss a deep model of what's going on...and something about that leaves me feeling uneasy. It's not a sentiment I see expressed much, and it's a relief to see a similar idea in this editorial.

Though this research highlights why a deep model is never going to be sufficient on its own. To many, it seems completely reasonable that additional training should lead to better outcomes. How could it not? Doesn't that just make sense? But things are probably far more complicated that that. Only data will show us where our intuition is wrong.

 

[NewTestament]

It does look like these 12 FAAOMPTs make a more efficient use of time. But I wouldn't be surprised if among those 12, at least half know one of the authors personally. I only say that to underscore that these dozen folks are probably high performers who were essentially hand-picked by the authors. They may have been great clinicians regardless of fellowship training.

Maybe I'm lost in my cynicism...If anything, this article seems to reinforce the idea that residency/fellowship doesn't make much of a difference.

Maybe they didn't know the authors personally, but the students who choose to do residencies and get accepted are usually some of the best students in the class. That was my experience. They achieved excellent grades and wanted to be the best they could be. I'm not saying other students are slackers, but some students are exceptional, and they are the ones who tend to pursue residencies. They do it simply to develop their own expertise and to spend as much time with a mentor as possible. That doesn't mean they'll be better clinicians. It's like the often-cited statistic that students who earn a four-year degree earn a million dollars more over a lifetime. Not only is that statistic inflated, but students who go to college would make more money without college because they're personally motivated and work hard.

I'm not sure residencies are the future for all students, but there's certainly more demand for them, and the profession needs to create more opportunities for aspiring students.

 

[ptisfun2]

(As an aside, has anyone else gotten tired of hearing PTs throw out one article to support their point of view, and then you go dig out the article, read it, and find that it's absolute bollocks and that the person referencing it probably didn't get past the abstract? I'm not even out of school yet, and I can see that this is going to be a growing chip on my shoulder for the rest of my career...)

Oh, that is not unique to PT....

 

[PT15years]

Hello everybody! I wanted to get everybody's thoughts on physical therapy residencies. Do you think that residencies will be required in the near future? What residency did you complete or are interested in and was it worth it? What do you think is the most interesting residency field? Thanks for the responses!

As one who quit a fellowship allow me to comment. 80% of it was academic research nonsense with little in actual evaluative training. The main focus of this fellowship was more a preparation for AAOMPT enrollment than the actual training. I was hesitant to attend but once decided was excited to be there---and later hugely disappointed. As far as residencies being "required" possibly the APTA would like to make a second huge mistake like they did with their fanaticism on the doctorate--which did not gain them reimbursable direct access like they thought and left the new generation of PTs with a program of extended internships which weren't necessary but extended the time to justify a "doctorate" and a loan they will never pay back. Nice going APTA--maybe you should step back a bit now. This is once again a pretentious profession that would like to make believe they are in the caliber of the MD but in reality remains ancillary. And just because we catch at times the MD mistakes doesn't mean we are primary. If you want to be a decent therapist try insisting you see patients one on one while you are immersed in continuing ed. It does wonders. Of course 80% of the field isn't doing that so how would they know what further education does what?

Once again the arrogant PT profession trying to be more than they actually are. I'll retire soon so it doesn't matter to me---but hey, go ahead and extend that debt paying with a residency PTs.

 

[BlueClaw]

As one who quit a fellowship allow me to comment. 80% of it was academic research nonsense with little in actual evaluative training. The main focus of this fellowship was more a preparation for AAOMPT enrollment than the actual training. I was hesitant to attend but once decided was excited to be there---and later hugely disappointed. As far as residencies being "required" possibly the APTA would like to make a second huge mistake like they did with their fanaticism on the doctorate--which did not gain them reimbursable direct access like they thought and left the new generation of PTs with a program of extended internships which weren't necessary but extended the time to justify a "doctorate" and a loan they will never pay back. Nice going APTA--maybe you should step back a bit now. This is once again a pretentious profession that would like to make believe they are in the caliber of the MD but in reality remains ancillary. And just because we catch at times the MD mistakes doesn't mean we are primary. If you want to be a decent therapist try insisting you see patients one on one while you are immersed in continuing ed. It does wonders. Of course 80% of the field isn't doing that so how would they know what further education does what?

Once again the arrogant PT profession trying to be more than they actually are. I'll retire soon so it doesn't matter to me---but hey, go ahead and extend that debt paying with a residency PTs.

Chill

 

[Ndebt]

There is truth to blueclaw's answer however do we really want direct access? Think about the liability aspect, who's to blame if you injure a patient because of an underlying condition that you did not notice? Usually the doctor, but if we bypass that then we've got serious liability concerns. I think the switch to DPT was inevitable, it's happening across the board with all professions. I do believe the apta could make a greater difference if they would control the rise in programs especially those that are online and take over 100 people a semester or trimester.

 

[Azimuthal]

There is truth to blueclaw's answer however do we really want direct access? Think about the liability aspect, who's to blame if you injure a patient because of an underlying condition that you did not notice? Usually the doctor, but if we bypass that then we've got serious liability concerns. I think the switch to DPT was inevitable, it's happening across the board with all professions. I do believe the apta could make a greater difference if they would control the rise in programs especially those that are online and take over 100 people a semester or trimester.

The liability issues have been addressed within the profession extensively. We are educated in medical screening and use a lot of the same screening, examination protocols as the other professions (Ottawa ankle rule, etc.). We have been doing this quite a while now ;-). Refer out immediately for red flags or if there is no change in status after 4 or so sessions, etc. The guy with the rant is right about one thing, we will never be equal to MD's. That's because we are two separate professions. We are not here to replace MDs, we are here to work with them.

 

[jesspt]

There is truth to blueclaw's answer however do we really want direct access? Think about the liability aspect, who's to blame if you injure a patient because of an underlying condition that you did not notice? Usually the doctor, but if we bypass that then we've got serious liability concerns. I think the switch to DPT was inevitable, it's happening across the board with all professions. I do believe the apta could make a greater difference if they would control the rise in programs especially those that are online and take over 100 people a semester or trimester.

" Usually the doctor"

So, a PT injures a patient that is under their care, and the physician is liable? I've got news for you - you're liable. Which is why we screen for red flags and do a review of systems when necessary.