Ryan Johnson studied as a resident in the APTA credentialed IPA Orthopedic Residency and currently practices at IPA Manhattan in New York City after three months of mentoring on FMT in India to begin his Fellowship training through the AAOMPT credentialed
I frequently am approached by colleagues who ask a very simple question, but one that often receives very uncertain answers: “What should I do after I graduate?” I, however, feel very confident in my answer when I am asked this question, which often throws the inquirer off-guard as they are expecting another vague and open-ended response.
My answer is very direct and simple:
1. Start studying a systematic approach to patient care for the patient population with which you will be working.
2. If at all possible, find a place where you can get direct and intentional mentorship from someone who is very good at his/her craft (preferably your mentor is so good with their patient outcomes that you struggle to believe you could ever be as effective).
As any physical therapist who has dedicated themselves to striving for excellence in their craft can attest to, there is a SIGNIFICANT learning curve that occurs over the first 3-5 years out in practice. Knowing many PTs who have been in the field for over 30 years, I can tell you that an absolute consistent statement is, “If I could only go back and treat that patient with the skills and knowledge that I have now!” And, the way each of these experts and leaders in the field have attained those skills and knowledge is through thousands of hours of intentional practice in patient care and constantly assessing and reassessing their patients to understand what patient preferences and presenting symptoms and comorbidities respond well to [enter your choice of intervention here].
I believe wholeheartedly that a residency and fellowship track will slingshot new grads (or PTs who are changing practice settings) into a place where they feel competent and proficient caring for patients in that practice setting. I was lucky to find this in the Institute of Physical Art’s Orthopedic Residency. In this residency we are required to attend six lab intensive weekend continuing education courses in Functional Manual Therapy (FMT). This approach, instructed solely through the Institute of Physical Art (IPA), is an integrative manual therapy approach that allows a physical therapist to effectively manage the mechanical, neuromuscular and motor control dysfunctions in patients across the spectrum from neurological to orthopedic. Other aspects of the residency include reviewing journal articles and textbooks and reporting on how that information can be integrated into clinical practice. Additionally, and most importantly, each resident is placed in a clinical practice under the mentorship of a Certified Functional Manual Therapist (CFMT) where they will be seeing a full caseload of patients and be receiving feedback and mentorship on those patients. This is important because it allows each resident’s mentor to see and enhance the day-to-day clinical reasoning and long-term clinical reasoning of that resident based on REAL PATIENTS. This allows for very tangible learning experiences and assistance on a daily basis on the resident’s own patient load, and through guidance discover what dysfunctions and impairments may help patients get over plateaus. This experience and mentorship is invaluable!
Learning the FMT approach allows a resident or new graduate to learn a systematic approach to patient care which creates a framework and structure through with to view each patient who comes into the room. I think this is extremely important for new graduates! Study an approach, whether it be FMT, Maitland, Mackenzie, Norwegian, Mulligan, Sarhmann, Paris, NDT, PNF, etc. This way, you have a focused treatment approach instead of a plethora of random interventions that don’t fit together in a systematic approach. Once you have a framework, you can then branch out and start integrating other treatment approaches and paradigms into your repertoire. In my experience, poor patient care comes from confused physical therapists who have no idea how to integrate the mass amount of eclectic treatment techniques they have learned.
The IPA promotes some of the most forward thinking and multifarious studied professionals in the physical therapy profession, willing to integrate interventions from many different approaches to attain optimal patient outcomes. However, unlike new graduates, resident directors are able to help their residents understand how to synthesize the myriad of treatment techniques under the patient management framework of FMT. Many of the CFMTs work in practice settings where they see orthopedic, neurological, pediatric, geriatric and chronic pain patients, meaning they have to be good at managing lots of patient types! To achieve their certification, they have been tested in not only written tests, but also an intensive week of practical tests where they are evaluated extensively on their ability to actually achieve measurable and tangible results with patients. When looking for a residency mentor, make sure your residency has mentors that have skill and knowledge sets that you value as a resident, and chose those mentors based on the fact that they are SIGNIFICANTLY better than you at achieving outstanding patient outcomes.
Another IPA resident (Peter Rumford, PT, MS-DPT, CSCS) stated that, “The IPA residency promotes Evidence Informed/Enhanced Practice instead of Research Based Practice, being pushed as Evidence Based Practice, that is taught in other residency programs.” This Research Based Practice paradigm has a couple significant flaws in my opinion, including undervaluing the wisdom that an advanced clinician can attain over thousands of hours of patient care (i.e. Level 5 which is “worse evidence” than poor quality cohort or low quality RCTs) and losing the coherent structural framework of a treatment paradigm. New graduates, I implore you, never underestimate the wisdom that can come from 30-40 years of dedicated practice in physical therapy! Always be open to guidance from more experienced physical therapists, but never blindly accept anything without clinically testing each piece of advice.
In summary, learning from a trained therapist who understands the mentoring process and is dedicated to your development is invaluable. If you are looking to get on the fast track, sign up for a residency!