Brad Grohovsky, PT, DPT
Buzz Lightyear to the rescue!
One of the most iconic characters from a “Millennial’s“ childhood coined the phrase that appropriately encompasses both the boundless dreams of a child and the newly-graduated PT as he/she enters the working world and begins raising a family - “To infinity and beyond!”. Enthusiastic new professionals arrive to the clinical realm much like Buzz who believes that he is much more than just Andy's toy; an actual space ranger destined to save the galaxy. We arrive invigorated, expecting our careers to soar having been supplied a plane in PT school, but not yet mastering the Art of flight. Too often with the stresses of increasing patient loads, decreased reimbursement and declining continuing education compensation PT’s quickly become frustrated by a feeling of professional stagnation - Burnout: we begin questioning the profession and if it’s even worth it to continue treating patients.
Physical Therapy continues to grow at an astonishing rate - from 3,499 graduates 30 years ago to 5,199 graduates 10 years ago and a projected 8,633 graduates in 2015.(1) We are very much in our teenage years of maturity in the medical community and are experiencing the trials and tribulations of acceptance as we develop our role in medicine. We must accept the struggles that come with initiation and maturity, remaining vigilant as we navigate the waters of continued growth. The necessity for our skills requires that we continue to hone our expertise so that our decisions are backed by the latest research (i.e. Evidence-based medicine), but we must not allow a narrow vision of an evidence-only philosophy to hinder our reasoning and challenging of conventional treatment approach. We must in fact challenge and push our profession and ourselves to new heights. The next step in our growth is competence through Residency and Fellowship experience.
Trial by Fire
My obsession with all things mechanical began as a kid growing up in rural Southern Kentucky. Growing up a "country boy", I was always out with my friends looking for the next adventure - building a new fort for paintball matches, jumping a new creek on an ATV, later fixing the ATV that I broke trying to jump the new creek....you get the idea. It was all about the adventure - and the biggest part of the adventure was figuring out what worked, what didn't, why it didn't, and how I could make it work the next time. As I grew into my teenage years these habits and hobbies molded with my lifestyle - primarily my car and truck. I was obsessed with how things worked and when they didn't, how I could make them work. Truck leaking oil? It's cool I'll just take the engine apart, replace the gasket and put it back together (sorry dad). No more leak.
Fast-forward 10 years. As a physical therapist the most frequent question that we are asked by our patients is "What got you into this profession?". More often than not it is a personal story about our own injuries and treatments that we received earlier in life. Trust me, I had my share of broken bones, torn ligaments and crushed ego through my years of trial and error. However, a couple of months ago while I was answering this question I had a sudden epiphany of my past. Instead of the usual answer I said, "because I have always like to fix things that aren't working efficiently and what is more rewarding than getting you up and running again!" I suppose it is this unconscious drive that has led me to the path of Residency. What carpenter can truly build a solid house on a solid foundation without first being an expert’s apprentice?!
As new graduates we are equipped with a toolbox that is overflowing with treatment options and cool evaluation tools. But with no more than 45 weeks of clinical experience in several different settings, we have never been mentored on how to organize and utilize our tools effectively and find ourselves using a screwdriver to hammer a nail. With enough pressure and time, the nail will inch it’s way, but how much more efficient it is when we use a few sharp taps from a hammer? Truthfully, over time and with experience we will finally figure out that the hammer works better, but our health care climate is demanding results NOW and we must adapt or be left behind.
A History Lesson:
Dr. Kornelia Krug was honored with providing the 18th Maley Lecture at APTA Annual Conference in 2013. She outlined the advancement of residency education from the beginning and the direction that she views Residency education heading as outlined below.
“Kaiser Permanente in Hayward, California, is credited with the honor of the first physical therapy residency, founded in 1979. Currently there are 134 residencies and 31 developing residences. Residency training builds on professional (entry-level) education, which, in less than 3 decades, rapidly advanced from baccalaureate- to doctoral-level education. The breadth of the educational content grossly remained the same, yet the depth has been enhanced in many areas—but not in all. How do we decide what the curricular content of a residency should be?”
The Four Ingredients to Residency Education (Dr. Kulig):
1. Patients: Requiring sufficient volume and diversity and having an optimal interaction with the therapist. A postgraduate educational opportunity, without a significant number of meaningful patient interactions, is not a residency. Phone, Skype, Adobe Connect, or any other Internet media cannot substitute for a direct patient contact.
2. Mentors: Sufficient numbers and diversity - having an optimal interaction with the resident.
3. Teaching Philosophy: Must be well stated and lived by. A teaching philosophy is a self-reflective statement of beliefs about teaching and learning - Health, honesty, and dignity. Residents and their mentors need to take care of their own physical and emotional health to serve their patients with physical and emotional needs. Residents and their mentors need to be honest with themselves and their patients, and they need to deal with potential clinical conflicts with dignity.
4. Educational Mission: a statement suitable for a particular residency, the administrative unit, and institution in which the residency is housed. Formulating the mission of the residency would precede the development of the curriculum and would be revisited every few years. 1
Having currently completed my first of a two-year, outpatient residency program through the Institute of Physical Art (IPA) I can confidently say that I am 100% a more efficient, competent, and valuable practitioner for my employers/mentors, but more importantly my patient’s. The 45-minute bi-weekly co-treatment sessions, lunchtime discussions and constant access for advice and questions have proved invaluable in my maturation as a clinician. Now I not only treat very complex conditions, but I want them. There is no greater reward than witnessing a patient’s excitement when you provide them with the independence and efficiency that no one else has been able to achieve.
Recently, I was treating a patient with an extensive PMH including a recent 5-month hospitalization - a patient who is also scheduled for a TKA in two months. Although I am treating him for a number of issues, I am treating him as a “whole person” according to the IPA approach - After one Functional Manual Therapy(TM) treatment addressing his knee and associated lower extremity dysfunctions he gained enough range of motion to ride his bike for the first time in 30 years! Are you kidding me? How can I not get excited?!! BRING. IT. ON.
From my personal experience, The Institute of Physical Art Residency encompasses all of the pillars outlined by Dr. Kulig in their mission:
“The Functional Manual TherapyTM Residency couples aggressive training in orthopedic physical therapy techniques with current scientific evidence and rational to prepare the resident for effective clinical intervention. The curriculum methodically addresses the mechanical, neuromuscular, and motor control dysfunctions an orthopedic patient typically manifest. However, given that an exposure to a diverse patient population enhances the understanding of efficient function, the curriculum also includes exposure to the neurological patient, as well as sports and geriatric populations.” (3)
Mentors are not only found in the clinical setting, but everyone in the IPA family serves as mentors to one another through continued coursework and research as we continue to challenge each other to be great. Our unofficial motto (thanks Cheryl Wardlaw, IPA faculty and PT at Emory Center for Rehab Medicine):
Semper Appetunt - Always Seeking.
The American Physical Therapy Association’s recently adopted vision statement declares that we our unified and focused as a profession; “Transforming society by optimizing movement to improve the human experience.”
Transforming society begins with transforming our profession collectively and our clinical skills individually.
The APTA recognizes the importance of Residency and Fellowship opportunity moving forward as a profession and recently consolidated the online application process for Residency opportunity.
If you are looking to grow as a professional and clinician, I would highly recommend investigating not only a Residency, but engaging in the process with our Association. New Professionals will shape the future and determine which direction our ship will fly. How far will you go, how far will we soar? To adapt the wise words of Buzz Lightyear;
To a Residency and Beyond!
Also check out IPA Fellow Ryan Johnson’s recent PTHaven article on residency: http://www.pthaven.com/news_article/show/231856?referrer_id=1047291
PHYS THER January 2014 94:151-161; published ahead of print December 5, 2013, doi:10.2522/ptj.2013.maley.lecture
2. 2011–2012 Fact Sheet Physical Therapist Education Programs, CAPTE. Updated March 14, 2013. Available at: http://www.capteonline.org/Resources/. Accessed March 14, 2013.
Brad attended Simmons College in Boston, MA - where he graduated with his Doctorate in Physical Therapy in 2011. During his time in New England he served on the American Physical Therapy Association Student Assembly Board of Directors where he represented nearly 20,000 other PT students across the country. Following graduation, Brad enrolled in the Institute of Physical Art’s APTA Credentialed Orthopedic Residency where he spent three years studying in Annapolis, Maryland and was mentored by several of the most advanced manual physical therapist clinicians in the country - eventually gaining his Certification in Functional Manual Therapy (CFMT). Brad recently returned closer to home and has ventured into the entrepreneurial world as the co-developer and partner of the innovative business model IPA Physio Nashville; where he is bringing the FMT treatment/lifestyle approach to Tennessee and beyond. Brad's inspiration for molding his passion for his patients and profession with disruptive innovation: To improve the quality of life for all individuals and to empower his PT colleagues through inspired action. Check out Brad at LinkedIn and Twitter.